Objectives. The goal of this study was to compare the efficacy of elective stent implantation and balloon angioplasty for new lesions in small coronary arteries. Background. Palmaz-Schatz stents have been designed and approved by the Food and Drug Administration for use in coronary arteries with diameters ≤3.0 mm. The efficacy of elective stent placement in smaller vessels has not been determined. Methods. By quantitative coronary angiography, 331 patients in the Stent Restenosis Study (STRESS) I-II were determined to have a reference vessel <3.0 mm in diameter. Of these, 163 patients were randomly assigned to stenting (mean diameter 2.69 ± 0.21 ram), and 168 patients were assigned to angioplasty (mean diameter 2.64 ± 0.24 mm). The primary end point was restenosis, defined as ≤50% diameter stenosis at 6-month follow-up angiography. Clinical event rates at 1 year were assessed. Resters. Baseline clinical and angiographic characteristics were similar in the two groups. Procedural success was achieved in 1000 of patients assigned to stenting and in 92% of patients assigned to angioplasty (p < 0.001). Abrupt closure within 30 days occurred in 3.6% of patients in both groups. Compared with angioplasty, stenting conferred a significantly larger postprocedural lumen diameter (2.26 vs. 1.80 nun, p < 0.001) and a larger lumen at 6 months (1.54 vs. 1.27 mm, p < 0.001). Restenosis (≤50% diameter stenosis at follow-up) occurred in 34% of patients assigned to stenting and in 55% of patients assigned to angioplasty (p < 0.001). At 1 year, event-free survival was achieved in 78% of the stent group and in 67% of the angioplasty group (p = 0.019). Conclusions. These findings suggest that elective stent placement provides superior angiographic and clinical outcomes than balloon angioplasty in vessels slightly smaller than 3 min.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine