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A randomized comparison of the value of additional stenting after optimal balloon angioplasty for long coronary lesions

Final results of the additional value of nir stents for treatment of long coronary lesions (ADVANCE) study

Patrick W. Serruys, MD, PhD, FACC, FESC^*,*, David P. Foley, MRCPI, PhD, FACC, FESC^*, Martin-Jan Suttorp, MD, PhD, Benno J. W. M. Rensing, MD, PhD, Harry Suryapranata, MD, PhD, FESC, Phillipe Materne, MD, Arijan van den Bos, MD^||, Edouard Benit, MD, FESC, FACC^¶, Angelo Anzuini, MD^#, Wolfgang Rutsch, MD, FESC^**, Victor Legrand, MD, PhD, FESC, Keith Dawkins, MD, FRCP, Michael Cobaugh, Marco Bressers, MSc^||||, Bianca Backx, PhD^||||, William Wijns, MD, PhD^¶¶ and Antonio Colombo, MD, FACC, FESC^#

^* Erasmus University, Rotterdam, The Netherlands
Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
Ziekenhuis De Weezenlanden, Zwolle, The Netherlands
Hôpital de la Citadelle, Liège, Belgium
^|| Medisch Centrum "De Klokkenberg", Breda, The Netherlands
^¶ UZ Virga Jesse, Hasselt, Belgium
^# Centro Cuore Columbus, Milan, Italy
^** Universitätsklinikum Charité, Berlin, Germany
CHU Sart Tilman, Liège, Belgium
Wessex Cardiology Centre, Southampton, United Kingdom
Boston Scientific GmbH, Ratingen, Germany
^|||| Cardialysis, Rotterdam, The Netherlands
^¶¶ Onze Lieve Vrouw Ziekenhuis, Aalst, Belgium.

View larger version (19K): [in a new window]   figure 1 Cumulative distribution of minimal lumen diameter (mld) before the procedure (pre), after the procedure (post) and at six-month follow-up (fup) for the balloon angioplasty only group (n = 120; solid line) and the additional stenting group (n = 124; dashed line).

View larger version (15K): [in a new window]   Figure 2 Event-free survival during 300 days after the intervention (by the Kaplan-Meier method). Thickest line = additional stenting group (n = 145); medium-thick line = balloon angioplasty only group (n = 143); thin line = bail-out stenting group (n = 149).

View larger version (20K): [in a new window]   Figure 3 Logistic regression analysis of lesion length versus major adverse cardiac events (MACE) (top) and restenosis rate (bottom). Both relationships show an advantage of stenting over balloon angioplasty (BA) for shorter lesions; however, in the additional stenting group, there is a significant incremental increase in restenosis and MACE with increased lesion length, a phenomenon that is not seen with BA.