title: Conservative versus aggressive treatment strategy with angiographic guidance alone in patients with intermediate coronary lesions: The SMART-CASE randomized, non-inferiority trial.
abstract: BACKGROUND
  Although coronary angiography is still the technique most widely used to guide percutaneous coronary intervention (PCI), the appropriate angiographic indication of revascularization for intermediate coronary lesions remains controversial. The aim of this study was to compare conservative versus aggressive strategies with angiographic guidance alone in patients with intermediate coronary lesions.
  
  
  RESULTS
  A total of 899 patients with intermediate coronary lesions between 50% and 70% diameter stenosis by quantitative coronary analysis were randomly assigned to the conservative group (n=449) or the aggressive group (n=450). For intermediate lesions, PCI was performed using everolimus-eluting stents in the aggressive group, but was deferred in the conservative group. The primary end point was a composite of all-cause death, myocardial infarction, or any revascularization at 1year. The number of treated lesions per patient was 0.8±0.9 in the conservative group and 1.7±0.9 in the aggressive group (p<0.001). The cumulative rate of the primary endpoint was 7.3% in the conservative group and 6.8% in the aggressive group (the upper limit of the one-sided 95% confidence interval [CI], 3.4%; p=0.006 for non-inferiority with a predefined non-inferiority margin of 5.0%). The risk of death or myocardial infarction (hazard ratio [HR] 0.50; 95% CI, 0.19-1.33; p=0.17) and revascularization (HR 1.42; 95% CI, 0.80-2.52; p=0.23) was not significantly different between the 2 groups.
  
  
  CONCLUSIONS
  Conservative revascularization was non-inferior to aggressive revascularization for intermediate coronary lesions. Revascularization of intermediate lesions can be safely deferred in patients undergoing PCI with angiographic guidance alone.
  
  
  BACKGROUND
  URL: http://ClinicalTrials.gov. Unique identifier: NCT00743899.
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Chungnam National University Hospital, Daejeon, Republic of Korea. Electronic address: jojeong@cnu.ac.kr.
authors.forename: Jin-Ok
authors.initials: JO
authors.lastname: Jeong
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
authors.forename: Yong Hawn
authors.initials: YH
authors.lastname: Park
authors.affiliation: Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Chun
authors.affiliation: Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
authors.forename: Ju Hyeon
authors.initials: JH
authors.lastname: Oh
authors.affiliation: Hanmaeum Hospital, Jeju, Republic of Korea.
authors.forename: Dae Kyoung
authors.initials: DK
authors.lastname: Cho
authors.affiliation: Dankook University Hospital, Cheonan, Republic of Korea.
authors.forename: Seong-Hoon
authors.initials: SH
authors.lastname: Lim
authors.affiliation: Eulji Medical Center, Eulji University, Daejeon, Republic of Korea.
authors.forename: Yu Jeong
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: Dongsuwon General Hospital, Suwon, Republic of Korea.
authors.forename: Eul-Soon
authors.initials: ES
authors.lastname: Im
authors.affiliation: Seoul Medical Center, Seoul, Republic of Korea.
authors.forename: Kyung-Heon
authors.initials: KH
authors.lastname: Won
authors.affiliation: Inje University Ilsan Paik Hospital, Goyang, Republic of Korea.
authors.forename: Sung Yun
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Chung-Ang University Hospital, Seoul, Republic of Korea.
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: hcgwon@naver.com.
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
mesh_terms: D000368:Aged; D000072700:Conservative Treatment / Q000379:methods / Q000592:standards*; D017023:Coronary Angiography / Q000379:methods / Q000592:standards*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000592:standards; D000068338:Everolimus / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000592:standards*; D011446:Prospective Studies
chemical_list: D000068338:Everolimus
keywords: Angiography; Stenting