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Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty.

Publication ,  Journal Article
Bittl, JA; Chew, DP; Topol, EJ; Kong, DF; Califf, RM
Published in: J Am Coll Cardiol
March 17, 2004

OBJECTIVES: We conducted a systematic overview (meta-analysis) of randomized trials of balloon angioplasty versus coronary atherectomy, laser angioplasty, or cutting balloon atherotomy to evaluate the effects of plaque modification during percutaneous coronary intervention. BACKGROUND: Several mechanical approaches have been developed that ablate or section atheromatous plaque during percutaneous coronary interventions to optimize acute results, minimize intimal injury, and reduce complications and restenosis. METHODS: Sixteen trials (9,222 patients) constitute the randomized controlled experience with atherectomy, laser, or atherotomy versus balloon angioplasty with or without coronary stenting. Each trial tested the hypothesis that ablative therapy would result in better clinical or angiographic results than balloon dilation alone. RESULTS: Short-term death rates (<31 days) were not improved by the use of ablative procedures (0.3% vs. 0.4%, odds ratio [OR] 0.94 [95% confidence interval 0.46 to 1.92]), but periprocedural myocardial infarctions (4.4% vs. 2.5%, OR 1.83 [95% CI 1.43 to 2.34]) and major adverse cardiac events (5.1% vs. 3.3%, OR 1.54 [95% CI 1.25 to 1.89]) were increased. Angiographic restenosis rates (6,958 patients) were not improved with the ablative devices (38.9% vs. 37.4%, OR 1.06 [95% CI 0.97 to 1.17]). No reduction in revascularization rates (25.2% vs. 24.5%, OR 1.04 [95% CI 0.94 to 1.14]) or cumulative adverse cardiac events rates up to one year after treatment were seen with ablative devices (27.8% vs. 26.1%, OR 1.09 [95% CI 0.99 to 1.20]). CONCLUSIONS: The combined experience from randomized trials suggests that ablative devices failed to achieve predefined clinical and angiographic outcomes. This meta-analysis does not support the hypothesis that routine ablation or sectioning of atheromatous tissue is beneficial during percutaneous coronary interventions.

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Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 17, 2004

Volume

43

Issue

6

Start / End Page

936 / 942

Location

United States

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Humans
  • Coronary Artery Disease
  • Cardiovascular System & Hematology
  • Atherectomy, Coronary
  • Angioplasty, Laser
  • Angioplasty, Balloon, Coronary
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1102 Cardiorespiratory Medicine and Haematology
 

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Bittl, J. A., Chew, D. P., Topol, E. J., Kong, D. F., & Califf, R. M. (2004). Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty. J Am Coll Cardiol, 43(6), 936–942. https://doi.org/10.1016/j.jacc.2003.10.039
Bittl, John A., Derek P. Chew, Eric J. Topol, David F. Kong, and Robert M. Califf. “Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty.J Am Coll Cardiol 43, no. 6 (March 17, 2004): 936–42. https://doi.org/10.1016/j.jacc.2003.10.039.
Bittl, John A., et al. “Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty.J Am Coll Cardiol, vol. 43, no. 6, Mar. 2004, pp. 936–42. Pubmed, doi:10.1016/j.jacc.2003.10.039.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

March 17, 2004

Volume

43

Issue

6

Start / End Page

936 / 942

Location

United States

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Humans
  • Coronary Artery Disease
  • Cardiovascular System & Hematology
  • Atherectomy, Coronary
  • Angioplasty, Laser
  • Angioplasty, Balloon, Coronary
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1102 Cardiorespiratory Medicine and Haematology