Randomized Comparison of GR-II Stent and Palmaz-Schatz Stent for Elective Treatment of Coronary Stenoses

Author:

Lansky Alexandra J.1,Roubin Gary S.1,O’Shaughnessy Charles D.1,Moore Paul B.1,Dean Larry S.1,Raizner Albert E.1,Safian Robert D.1,Zidar James P.1,Kerr Jennifer L.1,Popma Jeffrey J.1,Mehran Roxana1,Kuntz Richard E.1,Leon Martin B.1

Affiliation:

1. From Lenox Hill Hospital (A.J.L., G.S.R., R.M., M.B.L.), New York, NY; the North Ohio Heart Center (C.D.O.), Elyria; Baptist Medical Center (P.B.M.), Montgomery, Ala; the University of Alabama at Birmingham (L.S.D.); Methodist Hospital (A.E.R.), Houston, Tex; William Beaumont Hospital (R.D.S.), Royal Oak, Mich; Duke Medical Center (J.P.Z.), Durham, NC; Brigham and Women’s Hospital (J.J.P.) and Beth Israel Deaconess Hospital (R.E.K.), Boston, Mass; and MED Institute (J.L.K.), West Lafayette, Ind.

Abstract

Background —This prospective multicenter randomized clinical trial was designed to evaluate the long-term angiographic and clinical outcomes of elective treatment with the GR-II stent compared with the Palmaz-Schatz (PS) stent in patients with coronary stenoses. Methods and Results —Seven hundred fifty-five patients with myocardial ischemia and de novo native coronary stenoses in 3- to 4-mm vessels were randomly assigned to the PS (375 patients) or the GR-II stent (380 patients). The primary end point was 12-month target lesion revascularization (TLR)-free survival. Angiography was performed at baseline and at follow-up in the first 300 consecutive patients to assess the frequency of angiographic restenosis. Procedure success was 98.5% for the GR-II stent and 99.4% for the PS stent ( P =0.19). At 30 days, patients assigned to the GR-II stent had a higher stent thrombosis rate (3.9% versus 0.3% for PS stent, P <0.001) and TLR rate (3.9% versus 0.5% for PS stent, P <0.001). The GR-II group had a higher follow-up restenosis frequency (47.3% versus 20.6% for the PS group, P <0.001) and a lower 12-month TLR-free survival rate (71.7% versus 83.9% for the PS group, P <0.001). Multivariate logistic regression analysis identified a smaller final stent minimal lumen diameter (odds ratio [OR] 2.49, 95% CI 1.56 to 3.98; P <0.001), diabetes mellitus (OR 2.14, 95% CI 1.42 to 3.22; P <0.001), and use of the GR-II stent (OR 1.78, 95% CI 1.20 to 2.64; P <0.01) as independent determinants of 12-month TLR. Conclusions —On the basis of these long-term follow-up data, we conclude that use of the GR-II stent should be limited to the acute treatment of abrupt or threatened closure after failed conventional balloon angioplasty procedures.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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