title: Angiographic and clinical outcomes of drug-eluting versus bare metal stent deployment in the Occluded Artery Trial.
abstract: BACKGROUND
  The majority of patients randomized to percutaneous coronary intervention (PCI) in the Occluded Artery Trial (OAT) and its angiographic substudy, the Total Occlusion Study of Canada 2 (TOSCA-2) were treated with bare metal stents (BMS). We aimed to determine if stenting of the target occlusion in OAT with drug-eluting stents (DES) was associated with more favorable angiographic results and clinical outcome when compared with treatment with BMS.
  
  
  METHODS
  TOSCA-2 DES was a prospective nonrandomized substudy that provided 1-year angiographic comparison of late loss and reocclusion in 25 patients treated with DES and in 128 treated with BMS. In addition, all PCI-assigned patients enrolled from the time when DES were first utilized were similarly categorized (DES n = 77, and BMS n = 386) and compared using the 3-year cumulative OAT primary combined endpoint of death, myocardial infarction, or Class-IV heart failure, as well as angina.
  
  
  RESULTS
  In-segment late loss was 0.14 +/- 0.45 mm for DES and 0.75 +/- 0.86 mm for BMS (P < 0.001). Corresponding binary restenosis rates were 13.0% and 44.3% (P = 0.005). Occlusion at 1 year was observed in 4.0 and 12.1%, respectively (P = 0.23). The 3-year cumulative primary event rate was 13.8% with DES and 12.5% with BMS (hazard ratio 1.08, 99% confidence intervals 0.44, 2.64; P = 0.83). Angina over time occurred less frequently in the DES group (P = 0.01).
  
  
  CONCLUSIONS
  Although the reduction of late loss and trend to reduction in reocclusion with the use of DES for PCI of persistently occluded IRA 3-28 days post myocardial infarction did not translate into a signal for reduction in death, reinfarction, or Class IV heart failure, DES use was associated with less angina over time. Further follow-up is warranted.
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Dzavík
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Buller
authors.forename: Gerard
authors.initials: G
authors.lastname: Devlin
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Carere
authors.forename: G B John
authors.initials: GB
authors.lastname: Mancini
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.forename: Pawel E
authors.initials: PE
authors.lastname: Buszman
authors.forename: James M
authors.initials: JM
authors.lastname: Rankin
authors.forename: Carlos
authors.initials: C
authors.lastname: Vozzi
authors.forename: John R
authors.initials: JR
authors.lastname: Ross
authors.forename: Sandra
authors.initials: S
authors.lastname: Forman
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Barton
authors.forename: A Gervasio A
authors.initials: AG
authors.lastname: Lamas
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D002170:Canada; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D054855:Drug-Eluting Stents; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D015607:Stents; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D008670:Metals; D010975:Platelet Aggregation Inhibitors