CLINICAL STUDIES
The French randomized optimal stenting trial: a prospective evaluation of provisional stenting guided by coronary velocity reserve and quantitative coronary angiography
Antoine Lafont, MD, PhD*,
Jean L. Dubois-Randé, MD, PhD ,
Philippe G. Steg, MD ,
Patrick Dupouy, MD,
Didier Carrié, MD ,
Pierre Coste, MD||,
Alain Furber, MD¶,
Farzin Beygui, MD**,
Laurent J. Feldman, MD, PhD,
Saliha Rahal, MD*,
Christophe Tron, MD,
Martial Hamon, MD,
Gilles Grollier, MD,
Philippe Commeau, MD||,
Pascal Richard, MD¶¶,
Patrice Colin, MD***,
Christophe Bauters, MD,
Gaetan Karrillon, MD,
François Ledru, MD,
Bernard Citron, MD||,
François Noel Marié, MD*,
Morton Kern, MD¶¶ F.R.O.S.T. Study Group
* Hôpital Boucicaut, Paris, France
Hôpital Henri Mondor, Créteil, France
Hôpital Bichat, Paris, France
Hôpital Purpan, Toulouse, France
|| Hôpital Bordeaux-Pessac, Bordeaux, France
¶ Hôpital d’Angers, Angers, France
** Hôpital Necker, Paris, France
Hôpital Charles Nicolle, Rouen, France
Hôpital Emile Muller, Mulhouse, France
Hôpital de la Côte de Nacre, Caen, France
|| Clinique Saint Martin, Caen, France
¶¶ Hôpital de Brabois, Nancy, France
*** Hôpital Antoine Béclère, Paris, France
Hôpital Cardiologique de Lille, Lille, France
Hôpital Lariboisière, Paris, France
Hôpital Broussais, Paris, France
|| Hôpital Gabriel Montpied, Clermont-Ferrand, France
¶¶ Saint Louis University Center, Saint Louis, Missouri, USA
Manuscript received October 28, 1999;
revised manuscript received January 28, 2000,
accepted March 30, 2000.
Reprint requests and correspondence: Prof. Antoine Lafont, Cardiology Department, Hopital Boucicaut, University Paris V, 78, rue de la Convention, Paris 75015, France.
antoine.lafont{at}bcc.ap-hop-paris.fr
OBJECTIVES
We sought to make a prospective comparison of systematic stenting with provisional stenting guided by Doppler measurements of coronary velocity reserve and quantitative coronary angiography.
BACKGROUND
Despite the increasing use of stents during percutaneous transluminal coronary angioplasty, it is unclear whether systematic stenting is superior to a strategy of provisional stenting in which stents are placed only in patients with unsatisfactory results or as a bail-out procedure.
METHODS
Two hundred fifty-one patients undergoing elective coronary angioplasty were randomly assigned either to provisional stenting (group 1, in which stenting was performed if postangioplasty coronary velocity reserve was <2.2 and/or residual stenosis  35% or as bail-out) or to systematic stenting (group 2). The primary end point was the six-month angiographic minimal lumen diameter (MLD). Major adverse cardiac events were secondary end points (death, acute myocardial infarction and target lesion revascularization).
RESULTS
Stenting was performed in 48.4% of patients in group 1 and 100% of patients in group 2 (p < 0.01). Six months after angioplasty, the MLD did not differ between groups (1.90 ± 0.79 mm vs. 1.99 ± 0.70 mm, p = 0.39), as was the rate of binary restenosis (27.1% vs. 21.4%, p = 0.37). Among patients with restenosis, 13/32 (40.6%) in group 1 but 100% (25/25) in group 2 had in-stent restenosis (p < 0.01). Target lesion revascularization (15.1% vs. 14.4% in groups 1 and 2 respectively, p = 0.89) and major adverse cardiac events (15.1% vs. 16.0%, p = 0.85) were not significantly different.
CONCLUSIONS
Systematic stenting does not provide superior angiographic results at six months as compared with provisional stenting.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | CVR | = coronary velocity reserve | | DEBATE | = Doppler End Points Balloon Angioplasty Trial Europe | | DESTINI | = Doppler End Point Stenting International Investigation Coronary Flow Reserve | | DS | = diameter stenosis | | MLD | = minimal lumen diameter | | PTCA | = percutaneous transluminal coronary angioplasty | | QCA | = quantitative coronary angiography | | SD | = standard deviation |
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