Optimal directional coronary atherectomy significantly reduced angiographic restenosis compared with conventional balloon angioplasty (31.4% vs 39.8%; P=0.016).
RCT (n=1,000)
Yes
Absolute Event Rate: 31.4% vs 39.8%
p-value: p=0.016
BACKGROUND: Previous directional coronary atherectomy (DCA) trials have shown no significant reduction in angiographic restenosis, more in-hospital complications, and higher 1-year mortality than conventional balloon angioplasty (percutaneous transluminal coronary angioplasty PTCA). DCA, however, has subsequently evolved toward a more "optimal" technique (larger devices, more extensive tissue removal, and routine postdilation to obtain diameter stenosis 3X normal was more common with DCA (16% versus 6%; P<.0001). Angiographic restudy (in 79.6% of eligible patients at 7.2+/-2.6 median, 6.9 months) showed a significant reduction in the prespecified primary end point of angiographic restenosis by DCA (31.4% versus 39.8%; P=.016). Clinical follow-up to 1 year showed nonsignificant 13% to 17% reductions in the DCA arm of the study for mortality rate (0.6% versus 1.6%; P=.14), target-vessel revascularization (17.1% versus 19.7%; P=.33), target-site revascularization (15.3% versus 18.3%; P=.23), and target-vessel failure (death, Q-wave myocardial infarction, or target-vessel revascularization, 21.1% versus 24.8%; P=.17). CONCLUSIONS: Optimal DCA provides significantly higher short-term success, lower residual stenosis, and lower angiographic restenosis than conventional PTCA, despite failing to reach statistical significance for reducing late clinical events compared with PTCA with stent backup.
Baim et al. (Tue,) conducted a rct in Coronary artery disease (n=1,000). Optimal directional coronary atherectomy (DCA) vs. Conventional balloon angioplasty (PTCA) was evaluated on Angiographic restenosis (p=0.016). Optimal directional coronary atherectomy significantly reduced angiographic restenosis compared with conventional balloon angioplasty (31.4% vs 39.8%; P=0.016).