title: Comparison of outcomes (early and six- month) of direct stenting with conventional stenting (a meta-analysis of ten randomized trials).
abstract: Although direct stenting (DS) is increasingly used in clinical practice instead of stent implantation after predilatation (conventional stenting [CS]), its impact has not been scientifically proved. We therefore performed, using Mantel-Haenszel analysis, a meta-analysis of the published randomized studies comparing DS with CS. Furthermore, all the key procedural data were systematically sought out and pooled. Ten trials (2,650 coronary lesions, 2,576 patients) were identified and entered into the analysis. Adopted angiographic exclusion criteria were homogeneous. DS, compared with CS, was found to have a similar success rate (98.7% vs 98.9%) and no specific complications. Across the studies, the mean rate of crossover to predilatation in the DS arm was 5.9%. Overall, DS was associated with a 17% procedural time (95% confidence interval [CI] 14% to 20%), a 18% fluoroscopic time (95% CI 15% to 21%), a 11% contrast volume (95% CI 9% to 14%), and a 22% cost reduction (95% CI 16% to 28%). In the early postintervention period, DS was associated with a trend toward reduction of each of the major adverse events (MACEs) and with a significant reduction of myocardial infarction (MI) + death (odds ratio [OR] 0.57, 95% CI 0.35 to 0.95). However, at 6 months, the OR (95% CI) for death, MI, target lesion revascularization, and MACEs were 0.47 (0.19 to 1.27), 0.72 (0.45 to 1.25), 1.07 (0.77 to 1.46), and 0.82 (0.63 to 1.08), respectively. In the subgroup of studies providing quantitative angiographic data, all the parameters were found to be similar between the CS and DS groups. In conclusion, the present meta-analysis shows that DS compared with CS, in selected coronary lesions, is safe, optimizes equipment use, and may enhance the early results of coronary interventions while warranting similar late clinical outcomes.
authors.affiliation: Institute of Cardiology, Catholic University, Rome, Italy. f.burzotta@eudoramail.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
authors.forename: Martial
authors.initials: M
authors.lastname: Hamon
authors.forename: Mario Attilio
authors.initials: MA
authors.lastname: Mazzari
authors.forename: Rocco
authors.initials: R
authors.lastname: Mongiardo
authors.forename: Remi
authors.initials: R
authors.lastname: Sabatier
authors.forename: Alessandro
authors.initials: A
authors.lastname: Boccanelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Schiavoni
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D019917:Blood Vessel Prosthesis Implantation / Q000191:economics; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000191:economics / Q000601:surgery; D003365:Costs and Cost Analysis / Q000191:economics; D018592:Cross-Over Studies; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D015607:Stents / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome