Comparing angiographic coronary revascularization strategies: a 'natural' experiment.
OBJECTIVE
To study the impact of intracoronary stents on clinical restenosis in the 'real world'.


METHODS
Retrospective comparison of the rates of clinical restenosis between two cohorts exposed to different strategies for percutaneous transcatheter intervention. The endpoint was the first of death, myocardial infarction, coronary artery bypass grafting, repeat percutaneous transluminal coronary angioplasty (PTCA) or repeat coronary angiography within nine months.


METHODS
Tertiary care cardiac referral centre serving a large, metropolitan population.


METHODS
Patients undergoing angiographic revascularization from January 1 to February 28, 1996 (the 'restricted' group [R], n=147) were compared with a before and after cohort (the 'usual' group [U], n=232, divided into those who underwent revascularization between November 1 and November 30, 1995, and those who underwent revascularization between April 1 and May 31, 1996).


METHODS
The R group was revascularized during a period of economic constraint, which imposed a shortage on stent availability. The U cohort underwent revascularization before and after the shortage (an 'unrestricted' environment for stent usage).


RESULTS
There was no difference in clinical restenosis rates between the R (34.7%) and U (37.9%) groups (P=0.524, OR R/U=0.915, 95% CI 0.694 to 1.206). Also, the rate of clinical restenosis was the same among patients who underwent PTCA without stent insertion (34.8%) and those who received a stent (39.4%) (P=0.368, OR=1.13, 95% CI 0.87 to 1.44).


CONCLUSIONS
At the authors' institution, a restricted stenting policy did not result in a higher clinical restenosis rate than that of usual practice.
Kassam
S
S
Mount Sinai Hospital, Toronto, Canada.
Goel
V
V
Lazzam
C
C
Detsky
A S
AS
D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention; D015607:Stents; D016896:Treatment Outcome