Randomized Comparison of Primary Stenting and Provisional Balloon Angioplasty Guided by Flow Velocity Measurement

• DOI: 10.1161/01.cir.102.24.2930
• Publication Date: 2012-06-12T00:42:29Z
• Authors: Patrick W. Serruys; Bernard de Bruyne; Stéphane Carlier; José Eduardo Sousa; Jan Piek; Toshiya Muramatsu; Chris Vrints; Peter Probst; Ricardo Seabra-Gomes; Ian Simpson; Vasilis Voudris; Olivier Gurné; Nico Pijls; Jorge Belardi; Gerrit-Anne van Es; Eric Boersma; Marie-Angèle Morel; Ben van Hout
• Keywords: Angioplasty; EMC 05-01-43-06-04; Cost-benefit analysis; Random allocation; EMC NIHES-05-63-02 Quality; Stents; Balloon; 3. Good health

Background —Coronary stenting improves outcomes compared with balloon angioplasty, but it is costly and may have other disadvantages. Limiting stent use to patients a suboptimal result after angioplasty (provisional angioplasty) be as effective less expensive. Methods Results —To analyze the cost-effectiveness of provisional scheduled for single-vessel were first randomized receive primary (97 patients) or guided by Doppler flow velocity angiography (523 patients). Patients in latter group further optimization either additional termination procedure investigate what “optimal.” An optimal was defined reserve >2.5 diameter stenosis <36%. Bailout needed 129 (25%) who an obtained 184 523 (35%). There no significant difference event-free survival at 1 year between (86.6%) (85.6%). Costs significantly higher (EUR 6573 versus EUR 5885; P =0.014). second randomization showed that also more (1-year event free survival, 93.5% 84.1%; =0.066). Conclusions —After follow-up, expensive without clinical benefit. The beneficial value not limited angioplasty.