CLINICAL STUDIES
Long-term analysis of conventional coronary balloon angioplasty and an initial "stent-like" result
The NHLBI PTCA registry
David R. Holmes, Jr., MD, FACC*,
Kevin E. Kip, MSPH ,
Wanlin Yeh, MS,
Sheryl F. Kelsey, PhD,
Katherine M. Detre, MD, DrPH, FACC,
David O. Williams, FACC for the Investigators of the NHLBI PTCA Registry
* Mayo Clinic, Rochester, Minnesota, USA
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
Manuscript received January 15, 1998;
revised manuscript received April 27, 1998,
accepted May 8, 1998.
Address for correspondence: Kevin E. Kip, University of Pittsburgh, Graduate School of Public Health, Epidemiology Data Coordinating Center, 127 Parran Hall, 130 DeSoto Street, Pittsburgh, Pennsylvania
kip{at}edc.gsph.pitt.edu
Objectives. We examined the influence of an initial "stent-like" result on long-term outcome in patients in the 1985–86 NHLBI PTCA Registry.
Background. Stent use in selected patients is associated with improved angiographic and short-term clinical outcome; however, due to potential for in-stent restenosis and high costs of stents, there is interest in a strategy of more optimal dilatation to achieve a "stent-like" result without a stent. The long-term outcome of patients with a "stent-like" percutaneous transluminal coronary angioplasty (PTCA) remains unknown.
Methods. Ten-year outcome was compared between 225 successfully treated patients with and 1,764 successfully treated patients without an initial "stent-like" result ( 1 lesion dilated to  10% stenosis). The sample had 75% and 80% power, respectively, to detect an absolute difference of 8% in the 10-year rate of death and myocardial infarction (MI) between the two groups.
Results. Ten-year rates of death and MI were similar between the stent-like and non–stent-like groups (22.3% vs. 22.2%, 17.6% vs. 17.9%), however, there was less target lesion revascularization in the stent-like group (30.2% vs. 36.8%). In subgroup analysis of patients with multivessel disease, those with a stent-like result had less follow-up bypass surgery (25.2% vs. 32.7%), yet more repeat PTCA (53.8% vs. 42.7%). These findings were unaffected by adjustment for differences in baseline characteristics between the two patient groups.
Conclusions. Achievement of an initial stent-like result via balloon angioplasty alone may not appreciably reduce the long-term risk of death or MI, nor confer equivalent clinical benefit as achieving a stent-like result with a stent.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass graft surgery | | ECG | = electrocardiogram | | MI | = myocardial infarction | | MVD | = multivessel disease | | NHLBI | = National Heart, Lung, and Blood Institute | | NSL | = non–stent-like result | | PTCA | = percutaneous transluminal coronary angioplasty | | SL | = stent-like result | | SVD | = single vessel disease | | TLR | = target lesion revascularization |
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