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CLINICAL STUDIES

Sustained benefit of stenting chronic coronary occlusion: long-term clinical follow-up of the Stenting in Chronic Coronary Occlusion (SICCO) study

Per Anton Sirnes, MD, Svein Golf, MD, PhD^a, Yngvar Myreng, MD, PhD^a, Per Mølstad, MD, PhD^a, Per Albertsson, MD, PhD^*, Arild Mangschau, MD, PhD, Knut Endresen, MD, PhD and John Kjekshus, MD, PhD

^a The Feiring Heart Clinic, Feiring, Norway
^* Sahlgrenska University Hospital, Göteborg, Sweden
Ullevål Hospital, Oslo, Norway
National Hospital, Oslo, Norway

Manuscript received December 18, 1997; revised manuscript received April 6, 1998, accepted April 23, 1998.

Address for correspondence: Dr. Per Anton Sirnes, The Feiring Heart Clinic, N-2093 Feiring, Norway
psirnes{at}online.no

Objectives. This study assessed the long-term clinical outcome of stenting chronic occlusions.

Background. In the Stenting in Chronic Coronary Occlusion (SICCO) study, patients were randomized to additional stent implantation (n = 58) or not (n = 59) after successful recanalization and dilation of a chronic coronary occlusion. Palmaz-Schatz stents were used with full anticoagulation. The previously published 6-month angiographic follow-up results showed reduction of the restenosis rate from 74% to 32%.

Methods. The primary end point was the occurrence of major adverse cardiac events (cardiac death, lesion-related acute myocardial infarction, repeat lesion-related revascularization or angiographic documentation of reocclusion).

Results. Late clinical follow-up was obtained in all patients at 33 ± 6 months. Major adverse cardiac events occurred in 14 patients (24.1%) in the stent group compared with 35 patients (59.3%) in the percutaneous transluminal coronary angioplasty (PTCA) group (odds ratio 0.22, 95% confidence interval 0.10 to 0.49, p = 0.0002). Target vessel revascularization (including failed PTCA attempts) was performed in 24% of the stent group and in 53% of the PTCA group (p = 0.002). There were no events in the stent group after 8 months, whereas events continued to occur in the PTCA group. By multivariate analysis, allocation to the PTCA group, left anterior descending coronary artery lesion and lesion length were significantly related to the development of major adverse cardiac events.

Conclusions. These data demonstrate the long-term safety and clinical benefit of stenting recanalized chronic occlusions. There is a continued risk of late clinical events related to nonstented lesions. Implantation of an intracoronary stent should therefore be considered after successful opening of a chronic coronary occlusion.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CI = confidence interval   DS = diameter stenosis   LAD = left anterior descending coronary artery   MLD = minimal lumen diameter   OR = odds ratio   PTCA = percutaneous transluminal coronary angioplasty   SICCO = Stenting in Chronic Coronary Occlusion   TLR = target lesion revascularization   TVR = target vessel revascularization

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