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The Beta Blocker and Clonidine Protocol


Lesson 3
Risk Stratification

14. PTCA versus PCI (Stent) - Take 2

Unfortunately, despite the really cool names, and the really great study design, and 10,347 patients, there was NO significant difference observed between the stent group and PTCA group in the rates of death or myocardial infarction. There was a difference in the number of people who needed a subsequent PTCA, but that is not a great result. "We found that there was no benefit to treatment A over treatment B, but we did find that if you get treatment A, we need to do it again." Twenty-three negative studies? I would have given up.

Not 23 negative studies!

Al Suwaidi J, Holmes DR Jr, Salam AM, Lennon R, Berger PB.
Am Heart J. 2004 May;147(5):815-22.

bullet 23 trials which received anti-platelet therapy
bullet 10,347 patients
bullet 5130 patients randomized to receive stent
bullet 5217 patients randomized to receive balloon angioplasty
bullet 902 (17 %) of patients crossed over from a strategy of balloon angioplasty to stent placement because of the inability to achieve a satisfactory result with a balloon.
bullet No significant difference was observed between the stent group and PTCA group in the rates of death or myocardial infarction
bullet Significant reduction in target vessel revascularization (odds ratio, 0.59; 95% CI, 0.50-0.70; P <.001)

 

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