Primary Stent Implantation Compared With PrimaryBalloon Angioplasty for Acute Myocardial Infarction:

A Meta-Analysis of Randomized Clinical TrialsMichael M. Zhu, MD, Alan Feit, MD, Hal Chadow, MD, Mahmood Alam, MD,

Tak Kwan, MD, and Luther T. Clark, MD

The clinical efficacy of primary angioplasty foracute myocardial infarction (AMI) is limited by

recurrent myocardial ischemia during the hospital stayand restenosis in the months thereafter.1 With theapplication of more effective poststenting antithrom-botic regimens2 and the improvement in stent implan-tation techniques,3 coronary stenting is no longer con-sidered contraindicated in thrombus-containing le-sions and has gained substantial popularity in thesetting of AMI. Recently, several randomized clinicaltrials have been conducted that compared coronarystenting and balloon angioplasty as the primary revas-cularization strategy for AMI.4–14In the present study,we performed a meta-analysis of all the reported ran-domized trials to assess the overall comparative effi-cacy of these 2 strategies on major clinical outcomesin AMI.

• • •Trials were identified through searching the MED-

LINE database (1990 to December 2000), and thescientific session abstracts inCirculation, Journal ofthe American College of Cardiology, and theEuro-pean Heart Journal(1995 to 2000). The referencelists of identified trials and reviews were also checkedfor relevant studies. Randomized trials that provideddata with respect to the outcomes of interest of thismeta-analysis were eligible for inclusion.

Death, reinfarction, target vessel revascularization(TVR), and the composite of major adverse cardiacevents (death, reinfarction, or TVR) over a follow-upof $6 months were the clinical outcomes studied inthis meta-analysis. Outcome definitions were accord-ing to each study protocol. For each trial the results atthe longest follow-up were extracted for this analysisand the data were retrieved according to the intention-to-treat principle. When the data for certain end pointswere not given, the principal investigators were con-tacted for extra details.

Odds ratio (OR) was used to assess the compara-tive effectiveness of primary stenting versus primaryangioplasty in each trial and was calculated accordingto the method of Woolf.15 A fixed-effects model usingthe Mantel-Haenszel method was used to pool theseORs.16 The extent of heterogeneity across studies wasexamined by the Breslow-Day test.16

We identified 11 randomized trials that comparedthese 2 reperfusion strategies. Six trials (Zwolle trial,4

Florence Randomized Elective Stenting in acute Cor-onary Occlusion [FRESCO],5 Gianturco-Roubin inAcute Myocardial Infarction [GRAMI],6 Primary An-gioplasty versus STent implantation in Acute myocar-dial infarction [PASTA],7 Stent Primary Angioplastyin Myocardial Infarction [Stent PAMI],8 and secondSTENTing In acute Myocardial infarction [STEN-TIM-2] 9) were published as full articles, and 5 (Jack-sch et al,10 Primary Stenting vs. Angioplasty in AcuteMyocardial Infarction [PSAAMI],11 PRImary Stent-ing for Acute Myocardial infarction [PRISAM]study,12 Controlled Abciximab and Device Investiga-tion to Lower Late Angioplasty Complication [CA-DILLAC], 13 and BErlin Stent Study in Acute Myo-cardial Infarction [BESSAMI]14) were presented asabstracts at the time of submission of this article. TheBESSAMI trial and the study by Jacksch et al wereexcluded because the reported data were insufficientfor this analysis. Taken together, 9 trials were sum-marized in this meta-analysis. These 9 trials random-ized a total of 4,120 patients, of whom 2,050 under-went coronary stenting and 2,070 underwent balloonangioplasty.

Table 1 lists some selected features of the 9 trials.Patients with cardiogenic shock were included inFRESCO, GRAMI, PASTA, and PSAAMI, but weregenerally excluded in the other trials. With regard toadjunctive therapy, the use of thrombolytic agents wasinfrequent. In terms of platelet glycoprotein IIb/IIIainhibitors, CADILLAC was the only trial that exam-ined the comparative efficacy of these 2 treatmentsalone and in combination with abciximab. Among therest of the trials, these antiplatelet agents were gener-ally not given, except in the PSAAMI trial, in which48% of each randomization arm (44 patients) receivedabciximab.

Detailed data from the 9 trials and the summaryresults of the meta-analysis are shown in Tables 2 and3, respectively. Figure 1 depicts the ORs and 95%confidence intervals (CIs) of the individual trials andthe pooled estimates. When all the studies were com-bined, no statistically significant difference in mortal-ity was found between these 2 treatment groups. How-ever, primary stenting was found to have a highlysignificant advantage in reducing the composite inci-dence of major adverse cardiac events during thestudy period. This benefit was mainly due to a reduc-tion in TVR rate. Furthermore, the overall analysisalso showed a nonsignificant reduction in the inci-dence of reinfarction in the stent group.

Besides the overall analysis that evaluated the en-tire collection of randomized data, the stent-alone andangioplasty-alone arms of the CADILLAC trial were

From the Division of Cardiovascular Medicine, SUNY Health ScienceCenter, Brooklyn, New York. Dr. Zhu’s address is: Division of Cardio-vascular Medicine, SUNY Health Sciences Center at Brooklyn, 450Clarkson Avenue, Brooklyn, New York 11203. E-mail: zhum24@hscbklyn.edu. Manuscript received December 19, 2000; revisedmanuscript received and accepted February 26, 2001.

297©2001 by Excerpta Medica, Inc. All rights reserved. 0002-9149/01/$–see front matterThe American Journal of Cardiology Vol. 88 August 1, 2001 PII s0002-9149(01)01645-9

also subgrouped with the rest of thetrials to estimate the comparative ef-ficacy of these 2 treatments whenIIb/IIIa inhibitors were generally notgiven (Table 3 and Figure 1). Thesubanalysis showed similar results,except that the difference in rein-farction rate between these 2 reper-fusion strategies was further wid-ened to approach statistical signif-icance.

Sensitivity analysis (Table 3) wasalso performed to assess the stabilityof the overall estimates with regardto the CADILLAC trial, which con-stituted about 50% of the total sam-ple size in the meta-analysis. No sub-stantial changes in the summary re-sults were observed even when theCADILLAC trial was excluded fromthe pooling. Moreover, in all of the

TABLE 1 Description of the Trials Included in the Meta-Analysis

TrialSites(n)

Patients(n)

SymptomsOnset

VesselDiameter First-Choice Stent

Crossover (%)Follow-Up§

(mo)Stent PTCA

Zwolle4 1 227 ,6 h* .3.0 mm Palmaz-Schatz 2 13 6FRESCO5 1 150 ,6 h* .2.5 mm Gianturco-Roubin 0 0 12GRAMI6 8 104 ,24 h .2.5 mm Gianturco-Roubin II 0 25 12PASTA7 6 136 ,12 h .2.5 mm Palmaz-Schatz 1 10 12Stent PAMI8 62 900 ,12 h 3.0–4.5 mm Palmaz-Schatz‡ 2 15 12STENTIM-29 17 211 ,12 h .3.0 mm Wiktor-GX 3 36 12PSAAMI11 1 88 ,6 h† .3.0 mm Tensum III 2 27 12PRISAM12 11 222 ,24 h .2.5 mm Wiktor 0 1 6CADILLAC13 76 2,082 ,12 h 2.5–4.5 mm MultiLink (Duet) 1 18 6

*Including patients who presented within 24 hours and who had evidence of ongoing ischemia.†Including patients who presented within 24 hours and who had evidence of ongoing ischemia, left heart failure, or cardiogenic shock.‡Heparin coated.§The longest follow-up time reported for each trial.PTCA 5 percutaneous transluminal coronary angioplasty.

TABLE 2 Data Extracted from the Randomized Trials Included in the Meta-Analysis

Trial

Randomization(no.) Death (%)

Reinfarction(%) TVR (%) MACE (%)

Stent PTCA Stent PTCA Stent PTCA Stent PTCA Stent PTCA

Zwolle4 112 115 1.8 2.6 0.9 7.0 3.6 16.5 5.4 20.0FRESCO17 75 75 2.7* 4.0* 2.7 2.7 8.0 26.7 13.3 34.7GRAMI6† 52 52 3.8 7.7 0.0 7.7 13.5 19.2 17.3 34.6PASTA7,18 67 69 4.5 8.7 — — 18.6 37.6 22.4 49.3Stent PAMI19 452 448 5.8 3.1 2.9 2.7 10.6 21.0 17.0‡ 24.8‡

STENTIM-29 101 110 3.0 1.9 4.0 5.5 17.8 28.2 19.8 28.2PSAAMI† 44 44 9.1 15.9 2.3 9.1 11.4 29.5 18.2 38.6PRISAM12† 110 112 0.0 0.9 — — 22.7 33.9 — —CADILLAC13§ 512 516 2.8 4.3 1.2 1.6 7.4 14.2 10.9‡ 19.3‡

CADILLAC13\ 525 529 3.8 2.3 2.3 2.1 5.0 12.1 10.8‡ 15.2‡

Summary 2050 2070 3.7 3.6 2.1 2.9 9.2 18.7 13.3 22.5

*Total cardiac death; †further information provided by author; ‡death/reinfarction/disabling stroke/TVR; §stent alone and angioplasty alone arms; \abciximabarms.

MACE 5 major adverse cardiac events; other abbreviation as in Table 1.

TABLE 3 Meta-Analysis Results*

OutcomeStent vs PTCA

Association(p value)

Homogeneity(p value)(6–12 mo) OR 95% CI

Overall analysisDeath 1.04 0.75–1.44 0.90 0.22Reinfarction 0.71 0.47–1.08 0.13 0.20TVR 0.43 0.36–0.52 ,0.001 0.64MACE 0.52 0.44–0.62 ,0.001 0.15

SubanalysisDeath 0.90 0.63–1.31 0.66 0.30Reinfarction 0.61 0.38–1.00 0.06 0.20TVR 0.44 0.36–0.54 ,0.001 0.59MACE 0.49 0.40–0.59 ,0.001 0.22

Sensitivity AnalysisDeath 1.06 0.68–1.65 0.89 0.34Reinfarction 0.58 0.34–1.01 0.07 0.13TVR 0.43 0.34–0.54 ,0.001 0.50MACE 0.48 0.38–0.60 ,0.001 0.15

*The analysis was performed both with (overall analysis) and without (subanalysis) the abciximab armsof the CADILLAC trial. The analysis was also performed without the CADILLAC trial (sensitivity analysis).

Other abbreviations as in Tables 1 and 2.

298 THE AMERICAN JOURNAL OF CARDIOLOGYT VOL. 88 AUGUST 1, 2001

meta-analyses performed, no statistically significantheterogeneity was observed across the studies.

• • •This meta-analysis did not find any statistically

significant mortality difference between these 2 reper-fusion strategies up to 6 to 12 months after AMI.Although the large Stent PAMI trial observed an ad-verse mortality outcome in the stent arm, such afinding was not confirmed by the latest large-scaleCADILLAC trial (OR [stenting:angioplasty] 0.63,95% CI 0.32 to 1.25 for the placebo arms and OR1.01, 95% CI 0.62 to 1.63 for the placebo plus abcix-imab arms) or by the other smaller trials (OR 0.61,95% CI 0.32 to 1.16). One factor that could haveaffected the mortality outcome was the inclusion ofpatients with cardiogenic shock. Four smaller trials(FRESCO, GRAMI, PASTA, and PSAAMI) includeda few shock patients. When such patients were ex-cluded from the analysis, the mortality difference re-mained nonsignificant (OR 1.05, 95% CI 0.70 to 1.55

when excluding and OR 1.17, 95% CI 0.83 to 1.66when including the abciximab arms of the CADIL-LAC trial). Taken together, the randomized trials didnot show a clear mortality difference between these 2treatment strategies. However, the currently availabledata are only based on a small number of events thatoccurred. The CIs of the meta-analysis are still wideand the point estimates are somewhat unstable. Moreextensive studies are needed to determine whether asmall but important mortality difference exists be-tween these 2 treatments. Importantly, the presentstudy population is of a relatively low-risk cohort, asindicated by the low 6- to 12-month mortality andreinfarction rates. Studies focusing on higher risk pa-tients such as those with cardiogenic shock areneeded, in whom the mortality difference, if it doesexist, is more readily detectable.

With regard to the outcome of reinfarction, onlythe subanalysis, which was confined to studies per-formed mostly without platelet IIb/IIIa inhibitors,

FIGURE 1. ORs and their 95% CIs for primary stenting versus primary angioplasty for risk of death, reinfarction, TVR, and major ad-verse cardiac events (MACE) over a 6- to 12-month follow-up after AMI. The meta-analysis was performed both without (subtotal)and with (total) the abciximab arms of the CADILLAC trial.

BRIEF REPORTS 299

found a borderline significant reduction in the 6- to12-month reinfarction rate in the stent group. Such abenefit was not found in the abciximab arms of theCADILLAC trial. Furthermore, even in the subanaly-sis, the positive findings were mostly driven by thesmaller studies (OR 0.33, 95% CI 0.15 to 0.75). Thelarge trials either showed a much more moderateeffect (OR 0.75, 95% CI 0.26 to 2.19 for the CADIL-LAC trial) or no beneficial effect at all (OR 1.08, 95%CI 0.49 to 2.38 for the Stent PAMI trial). Smallertrials when compared with larger trials are more likelyto be subject to publication bias.20 Overall, currentlyavailable data have not yet provided convincing evi-dence in support of a clear benefit of primary stentingin preventing reinfarction after AMI. As previouslydiscussed, the present study population has a rela-tively low-risk profile. Future trials, especially thoseenrolling higher risk patients, are needed to betterdefine this issue.

In contrast to the outcomes of death and reinfarc-tion, this meta-analysis has found reasonably consis-tent evidence that primary stenting is superior to pri-mary angioplasty in reducing the need for TVR over a6- to 12-month follow-up after AMI. The benefit wasobserved in all studies with different stent designs.Overall, the TVR rate was 9.2% for the stent groupand 18.7% for the angioplasty group, representing anabsolute risk reduction of 9.7% (95% CI, 8.0 to 11.1).Moreover, due to the substantially reduced need foradditional revascularization procedures, a reduction inthe composite end point of major adverse cardiacevents was also observed, in which the TVR end pointwas a major component.

This meta-analysis has several limitations. First,the randomized trials mainly focused on subsets ofpatients with AMI (e.g., those without cardiogenicshock and those with coronary anatomy suitable forstenting), and the trials were mostly conducted atcenters with expertise in coronary interventions inAMI. Caution should be taken when generalizingthese results to the broader-based population in clini-cal practice. Second, the unpublished trials contrib-uted more data to this meta-analysis than the pub-lished ones. The former, which were all completedtrials presented at major cardiology meetings, wereincluded in this study because they all compared pri-mary stenting with primary balloon angioplasty inAMI, and they all met the inclusion criteria of thisanalysis. Finally, this meta-analysis, like all meta-analyses, emphasized the summarization of resultsrather than the variability in outcome between studies.It remains to be further studied how factors, such asthe stent design and the baseline patient and lesioncharacteristics, contributed to clinical heterogeneitybetween the trials.

In summary, randomized trials have demon-strated consistent evidence that primary stenting issuperior to primary angioplasty in reducing TVRover a 6- to 12-month follow-up after AMI. How-ever, with regard to the “hard” end points of deathand reinfarction, the trials have not shown a clear

difference between these 2 reperfusion strategies,and these issues need to be further elucidated be-fore definite conclusions can be drawn.

Acknowledgment: We would like to thank JeremyWeedon, PhD, for helpful statistical advice, and DavidAntoniucci, MD, Cindy L. Grines, MD, Akiyoshi Ka-washima, MD, Alfredo Rodriguez, MD, PhD, ShigeruSaito, MD, Bruno Scheller, MD, and Gregg W. Stone,MD, for contributing and/or verifying data.

1. Stone GW, Grines CL, Topol EJ. Update on percutaneous transluminalcoronary angioplasty for acute myocardial infarction. In: Topol E, Serruys P, eds.Current Review of Interventional Cardiology. 2nd ed. Philadelphia, PA: CurrentMedicine, 1995:1–56.2. Barragan P, Sainsous J, Silvestri M, Bouvier JL, Comet B, Simeoni JB,Charmasson C, Bremondy M. Ticlopidine and subcutaneous heparin as an alter-native regimen following coronary stenting.Cathet Cardiovasc Diagn1994;32:133–138.3. Colombo A, Hall P, Nakamura S, Almagor Y, Maiello L, Martini G, GaglioneA, Goldberg SL, Tobis JM. Intracoronary stenting without anticoagulation ac-complished with intravascular ultrasound guidance.Circulation 1995;91:1676–1688.4. Suryapranata H, van’t Hof AW, Hoorntje JC, de Boer MJ, Zijlstra F.Randomized comparison of coronary stenting with balloon angioplasty inselected patients with acute myocardial infarction.Circulation 1998;97:2502–2505.5. Antoniucci D, Santoro GM, Bolognese L, Valenti R, Trapani M, Fazzini PF.A clinical trial comparing primary stenting of the infarct-related artery withoptimal primary angioplasty for acute myocardial infarction: results from theFlorence Randomized Elective Stenting in Acute Coronary Occlusions (FRES-CO) trial. J Am Coll Cardiol1998;31:1234–1239.6. Rodriguez A, Bernardi V, Fernandez M, Mauvecin C, Ayala F, Santaera O,Martinez J, Mele E, Roubin GS, Palacios I, Ambrose JA. In-hospital and lateresults of coronary stents versus conventional balloon angioplasty in acutemyocardial infarction (GRAMI trial) (Gianturco-Roubin in Acute MyocardialInfarction).Am J Cardiol1998;81:1286–1291.7. Saito S, Hosokawa G, Tanaka S, Nakamura S. Primary stent implantation issuperior to balloon angioplasty in acute myocardial infarction: final results of theprimary angioplasty versus stent implantation in acute myocardial infarction(PASTA) trial. PASTA Trial Investigators.Cathet Cardiovasc Interven1999;48:262–268.8. Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, Giambartolomei A,Brodie BR, Madonna O, Eijgelshoven M, Lansky AJ, O’Neill WW, Morice MC.Coronary angioplasty with or without stent implantation for acute myocardialinfarction. Stent Primary Angioplasty in Myocardial Infarction Study Group.N Engl J Med1999;341:1949–1956.9. Maillard L, Hamon M, Khalife K, Steg PG, Beygui F, Guermonprez JL,Spaulding CM, Boulenc JM, Lipiecki J, Lafont A, Brunel P, Grollier G, KoningR, Coste P, Favereau X, Lancelin B, Van Belle E, Serruys P, Monassier JP,Raynaud P. A comparison of systematic stenting and conventional balloonangioplasty during primary percutaneous transluminal coronary angioplasty foracute myocardial infarction. STENTIM-2 Investigators.J Am Coll Cardiol2000;35:1729–1736.10. Jacksch R, Niehues R, Knobloch W, Schiele Th. PTCA versus stenting inacute myocardial infarction (AMI) (abstr).Circulation 1998;98(suppl I):I–307.11. Scheller B, Hennen B, Severin-Kneib S, Markwirth T, Doerr T, Berg G,Schieffer H, Ozbek C. Follow-up of the PSAAMI study population (PrimaryStenting vs. Angioplasty in Acute Myocardial Infarction) (abstr).J Am CollCardiol 1999;33(suppl A):29A.12. Kawashima A, Ueda K, Nishida Y, Inoue N, Tanaka S, Kawamoto A,Miyazaki H, Tanaka N, Kato O, Okada T, Furukawa K, Tamai H. Quantitativeangiographic analysis of restenosis of primary stenting using wiktor stent foracute myocardial infarction: results from a multicenter randomized PRISAMstudy (abstr).Circulation 1999;100(suppl I):I–856.13. Stone GW, Grines CL, Cox DA, Stuckey T, Carroll JD, Guagliumi G,Rutherford BD, Essente P, Lansky AJ, Tcheng JE, Griffin J, Garcia E. Aprospective, randomized trial comparing primary balloon angioplasty with orwithout abciximab to primary stenting with or without abciximab in acutemyocardial infarction—primary endpoint analysis from the CADILLAC trial(abstr).Circulation 2000;102(suppl II):II-664.14. Schwimmbeck PL, Spencker S, Hohmann C, Horstkotte D, Behrens S,Pauschinger M, Morguet A, Kuersten B, Piper C, Schultheiss HP. Results fromthe Berlin Stent Study in Acute Myocardial Infarction (abstr).Circulation 2000;102(suppl II):II-813.15. Woolf B. On estimating the relationship between blood group and disease.Ann Human Genet1955;19:251–253.16. Breslow NE, Day NE. The analysis of case-control studies. In: Davis W, ed.

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vs stent implantation in AMI in Japan) trial (abstr).Circulation 1997;96(supplI):I-595.19. Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, Giambartolomei A,Brodie BR, Lansky AJ, O’Neill WW, Grines LL, Boura JA, Morice MC. StentPAMI. 12 month results and predictors of mortality.J Am Coll Cardiol2000;35(suppl A):402A.20. Dickersin K, Berlin JA. Meta-analysis: state-of-the-science.Epidemiol Rev1992;14:154–176.

An Optimal Diagnostic Threshold for Minimal StentArea to Predict Target Lesion Revascularization

Following Stent Implantation in NativeCoronary Lesions

Yoshihiro Morino, MD, Yasuhiro Honda, MD, Hiroyuki Okura, MD, Akio Oshima, MD,Motoya Hayase, MD, Heidi N. Bonneau, RN, MS, Richard E. Kuntz, MD, MSc,

Paul G. Yock, MD, and Peter J. Fitzgerald, MD, PhD

Intravascular ultrasound (IVUS) imaging has beenused to optimize stent implantation in coronary

arteries.1,2 Despite optimum angiographic appearance,stents are often underexpanded using IVUS criteria.Several studies have demonstrated that IVUS-derivedlumen dimensions (diameter or area) after stent place-ment predict the rate of restenosis.3–6 The applieddiagnostic value of these parameters has not beenestablished, because a working definition of adequatestent expansion has not been tested. In this study, abinary threshold for minimal stent area (MSA) thatminimizes target lesion revascularization (TLR) wasdetermined from a large cohort multicenter trial.

• • •The “Can Routine Intravascular Ultrasound Influ-

ence Stent Expansion” (CRUISE) trial was designedto compare IVUS-guided versus angiographic-guidedstenting as a substudy of the randomized STent Anti-thrombic Regimen Study (STARS).1,7 The use ofIVUS or angiography was assigned on a center-by-center basis.

From April 1996 to May 1997, 525 patients wereenrolled in the CRUISE trial, with 9-month clinicalinformation available for 499 patients (95.0%), inwhom 543 lesions were implanted with 1 or 2 Palmaz-Schatz (P-S, Cordis, Miami, Florida) stents. After theachievement of angiographic success, IVUS imagingwas then performed in all lesions. The IVUS datawere used either as documentary data for core labo-ratory analysis (angiographic-guided cohort), or toguide further percutaneous treatment (IVUS-guidedcohort). Those 2 groups were pooled for this analysis.

All IVUS studies were performed with a commer-cially available system (CVIS/Boston Scientific Corp,San Jose, California; 30-MHz). Intracoronary nitro-glycerin was injected before image acquisition. Areameasurements were performed with a commerciallyavailable planimetry software package (TapeMeasure2.0, Indec Systems, Inc., Mountain View, California)by the Cardiovascular Core Analysis Laboratory atStanford University. Only the IVUS image after thefinal procedure was used for this analysis. MSA wasdefined as cross-sectional stent area at the tightestsegment within the stent. Because P-S stents wereexclusively used in this trial, all measurements wereconfined to the intrastent borders. The proximal anddistal reference segments were defined as the locationin the native vessel with the least amount of diseasewithin 5 mm of the proximal and distal stent edges andbefore emergence of any major side branches.

Given that MSA was the primary focus of ourstudy, TLR, rather than target vessel revasculariza-tion, was selected as the clinical end point at 9-monthfollow-up.

Quantitative data were presented as a meanvalue 6 SD and qualitative data were presented asfrequencies. Multivariate analysis was performed withSPSS version 9.0 (SPSS Inc., Chicago, Illinois).

Baseline and procedural characteristics have been

From the Center for Research in Cardiovascular Interventions, StanfordUniversity Medical Center, Stanford, California; and Brigham andWoman’s Hospital, Harvard Medical School, Boston, Massachusetts.Dr. Morino was supported by a grant from the Getz-Stanford Schol-arship and the foreign cardiovascular fellow education fund fromStanford University, Stanford, California. Dr. Fitzgerald’s address is:Center for Research in Cardiovascular Interventions, Stanford Univer-sity Medical Center, 300 Pasteur Drive, H3554, Stanford, California94305-5637. Manuscript received December 28, 2000; revisedmanuscript received and accepted March 7, 2001.

TABLE 1 Multivariate Analysis to Predict Target LesionRevascularization

Variable p Value 95% CI

MSA (IVUS) 0.010 0.518–0.915MLD (angiography) NSReference diameter NSDiabetes NSHypertension NSDyslipidemia NSSmoking NSAge NSStent number NS

CI 5 confidence interval; MLD 5 minimal lumen diameter.

301©2001 by Excerpta Medica, Inc. All rights reserved. 0002-9149/01/$–see front matterThe American Journal of Cardiology Vol. 88 August 1, 2001 PII S0002-9149(01)01646-0