Investigators in the Florence Randomized Elective Stenting in Acute Coronary Occlusions - FRESCO
Stenting vs. PTCA for death, reinfarction, or revacularization in acute MI.
To compare stenting of the primary infarct-related artery (IRA) with optimal primary angioplasty for patients with an acute myocardial infarction.
Patients Screened: 223
Patients Enrolled: 150
Mean Follow Up: 6 months
Mean Patient Age: 62
Mean Ejection Fraction: 51%
Chest pain for > 30 min
ST elevation of at least 0.1 mV in two or more contiguous leads
Admission within 6 hours of symptom onset, or admission within 24 hours if there was evidence of continuing ischemia
Previous administration of fibrinolytic therapy
Stenosis of IRA of < 70%
Inability to identify IRA
Composite death, reinfarction or repeat target vessel revascularization within 6 months.
Angiographic evidence of restenosis or reocclusion at 6 months after randomization.
Intracoronary stents vs. balloon angioplasty.
IV heparin, aspirin, and ticlopidine.
Primary PTCA was attempted in 223 patients. 73 patients were not randomized due to unsuccessful primary PTCA or coronary anatomy. The remaining patients were randomized to stenting (n=75) or no further intervention (n=75).
One-month recurrent ischemia was 3% in the stent group, and 15% in the PTCA group (p=0.009). The restenosis or reocclusion rate was 3% in the stent group and 17% in the PTCA group (p=004).
At 6 months, the incidence of the primary end point was 9% in the stent group and 28% in the PTCA group (p=0.003); the incidence of restenosis or reocclusion was 17% in the stent group and 43% in the PTCA group (p=0.001).
Primary stenting of the IRA, compared with optimal primary angioplasty, results in a lower rate of major adverse events related to recurrent ischemia and a lower rate of angiographically detected restenosis or reocclusion of the IRA.
1. Journal of the American College of Cardiology 1998;31(6):1234-9. Final results
Clinical Topics: Invasive Cardiovascular Angiography and Intervention
Keywords: Myocardial Infarction, Chest Pain, Angioplasty, Balloon, Coronary, Stents
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