Long-term analysis of conventional coronary balloon angioplasty and an initial “stent-like” result : The NHLBI PTC registry

Objectives. We examined the influence of an initial “stent-like” result on long-term outcome in patients in the 1985–86 NHLBI PTC 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 strategy of more optimal dilatation to achieve “stent-like” result without stent. The long-term outcome of patients with “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 stent-like result had less follow-up bypass surgery (25.2% vs. 32.7%), yet more repeat PTC (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 vi balloon angioplasty alone may not appreciably reduce the long-term risk of death or MI, nor confer equivalent clinical benefit as achieving stent-like result with stent.