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CLINICAL RESEARCH

Coronary stent implantation is superior to balloon angioplasty for chronic coronary occlusions

Six-year clinical follow-up of the GISSOC trial

Paolo Rubartelli, MD^*,*, Edoardo Verna, MD, Luigi Niccoli, MD, Corinna Giachero, MD^*, Marco Zimarino, MD, Guglielmo Bernardi, MD^||, Corrado Vassanelli, MD^¶, Luigi Campolo, MD^#, Eugenio Martuscelli, MD^** Gruppo Italiano di Studio sullo Stent nelle Occlusioni Coronariche (GISSOC) Investigators

^* Ospedale San Martino, Genoa, Italy
Ospedale di Circolo, Varese, Italy
Spedali Civili, Brescia, Italy
Università di Chieti, Chieti, Italy
^|| Ospedale Santa Maria della Misericordia, Udine, Italy
^¶ Università del Piemonte Orientale, Novara, Italy
^# Casa di Cura Privata Villa Azzurra, Rapallo, Italy
^** Policlinico Umberto I, Rome, Italy

Manuscript received October 22, 2002; revised manuscript received December 3, 2002, accepted December 12, 2002.

^* Reprint requests and correspondence: Dr. Paolo Rubartelli, UO Cardiologia, Ospedale San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
paolo.rubartelli{at}hsanmartino.liguria.it

OBJECTIVES: We investigated whether the benefits of stent implantation over balloon percutaneous transluminal coronary angioplasty (PTCA) for treatment of chronic total coronary occlusions (CTO) are maintained in the long term.

BACKGROUND: Several randomized trials have shown that in CTO, stent implantation confers clinical and angiographic mid-term outcomes superior to those observed after PTCA. However, limited information on the long-term results of either technique is available.

METHODS: Six-year clinical follow-up of patients enrolled in the Gruppo Italiano di Studio sullo Stent nelle Occlusioni Coronariche (GISSOC) trial was performed by direct visit or telephone interview. Major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, target lesion revascularization (TLR), and anginal status, were recorded.

RESULTS: Freedom from MACE at six years was 76.1% in the stent group, compared with 60.4% in the PTCA group (p = 0.0555). This difference was due mainly to TLR-free survival rates (85.1% vs. 65.5% for the stent and PTCA groups, respectively; p = 0.0165). Eleven patients underwent TLR after the nine-month follow-up visit (stent group: n = 5; PTCA group: n = 6); however, in most cases, restenosis of the study occlusion was evident at nine-month angiography.

CONCLUSIONS: This study represents the longest reported clinical follow-up of patients after percutaneous recanalization of CTO and demonstrates that the superiority of stent implantation over balloon PTCA is maintained in the long term. Stent and PTCA results appear to remain stable after nine-month angiographic follow-up. Stent implantation in CTO that can be recanalized percutaneously is therefore a valuable long-term therapeutic option.

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   CTO = chronic total coronary occlusion   GISSOC = Gruppo Italiano di Studio sullo Stent nelle Occlusioni Coronariche   MACE = major adverse cardiac events   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   TIMI = Thrombolysis In Myocardial Infarction   TLR = target lesion revascularization

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