Stenting in Chronic Coronary Occlusion (SICCO): a randomized, controlled trial of adding stent implantation after successful angioplasty.
OBJECTIVE
This study investigated whether stenting improves long-term results after recanalization of chronic coronary occlusions.


BACKGROUND
Restenosis is common after percutaneous transluminal coronary angioplasty (PTCA) of chronic coronary occlusions. Stenting has been suggested as a means of improving results, but its use has not previously been investigated in a randomized trial.


METHODS
We randomly assigned 119 patients with a satisfactory result after successful recanalization by PTCA of a chronic coronary occlusion to 1) a control (PTCA) group with no other intervention, or 2) a group in which PTCA was followed by implantation of Palmaz-Schatz stents with full anticoagulation. Coronary angiography was performed before randomization, after stenting and at 6-month follow-up.


RESULTS
Inguinal bleeding was more frequent in the stent group. There were no deaths. One patient with stenting had a myocardial infarction. Subacute occlusion within 2 weeks occurred in four patients in the stent group and in three in the PTCA group. At follow-up, 57% of patients with stenting were free from angina compared with 24% of patients with PTCA only (p < 0.001). Angiographic follow-up data were available in 114 patients. Restenosis (> or = 50% diameter stenosis) developed in 32% of patients with stenting and in 74% of patients with PTCA only (p < 0.001); reocclusion occurred in 12% and 26%, respectively (p = 0.058). Minimal lumen diameter (mean +/- SD) at follow-up was 1.92 +/- 0.95 mm and 1.11 +/- 0.78 mm, respectively (p < 0.001). Target lesion revascularization within 300 days was less frequent in patients with stenting than in patients with PTCA only (22% vs. 42%, p = 0.025).


CONCLUSIONS
Stent implantation improved long-term angiographic and clinical results after PTCA of chronic coronary occlusions and is thus recommended regardless of the primary PTCA result.
Feiring Heart Clinic, Norway.
P A
PA
Sirnes
S
S
Golf
Y
Y
Myreng
P
P
Mølstad
H
H
Emanuelsson
P
P
Albertsson
M
M
Brekke
A
A
Mangschau
K
K
Endresen
J
J
Kjekshus
D015906:Angioplasty, Balloon, Coronary; D002908:Chronic Disease; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000628:therapy*; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents / Q000009:adverse effects