Direct Coronary Stenting vs. Conventional Stenting in Treating Coronary Heart Disease: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Lei ^1,2 , MA Bin ¹ , YANG Kehu ¹ ,  YAO Yali ²

1. Evidence-Based Medicine Center of Lanzhou University, Lanzhou 730000, China;2. The First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

YAO Yali, Email: yaoyalifs@yahoo.com.cn

Keywords：

Direct coronary stenting; Conventional stenting; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20120136

Video：

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Objective 　To assess the safety and effectiveness of direct stenting (DS) versus conventional stenting (CS) with predilation in clinical practice.
Methods 　Such databases as PubMed, EMbase, The Cochrane Library (Issue 3, 2011), CBM, VIP and CNKI were searched from the date of their establishment to April 2011, to collect the randomized controlled trials (RCTs) on DS vs. CS. The quality of RCTs was critically appraised, and the data were extracted and cross-checked by two reviewers independently. Meta-analyses were conducted using RevMan 5.0 software.
Results 　A total of 24 RCTs involving 6 666 patients were included. The results of Meta-analyses showed that DS took shorter operative time compared with CS (MD=–3.36, 95%CI –4.41 to –2.30, P lt;0.000 01) with acute gain (luminal diameter) during operation (MD=–0.01, 95%CI –0.04 to 0.02, P=0.64). But there were no significant differences in the incidence of major adverse cardiac events during six-month follow-up (OR=0.89, 95%CI 0.69 to 1.14, P=0.35) and restenosis (OR=1.02, 95%CI 0.82 to 1.26, P=0.88).
Conclusion 　Current evidence shows that DS is not superior to CS. This conclusion still needs to be further proved by well-designed and large scale RCTs with longer follow-up duration.

Citation： LIU Lei,MA Bin,YANG Kehu,YAO Yali. Direct Coronary Stenting vs. Conventional Stenting in Treating Coronary Heart Disease: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2012, 12(7): 764-769. doi: 10.7507/1672-2531.20120136 Copy

1.	陆再英, 钟南山, 等. 内科学(第7版). 人民卫生出版社, 2008: 272.
2.	颜红兵, 朱小玲, 高海. 冠心病介入治疗临床随机试验. 中国环境科学出版社, 2005: 简介.
3.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions: version 5.0.1 Cochrane Collaboration, 2008.
4.	Danzi GB, Capuano C, Fiocca L, et al. Stent implantation in patients with a single, noncalcified coronary artery lesion. Am J Cardiol, 1999, 84(10): 1250-1253.
5.	Ormiston JA, Webster MWI, Ruygrok PN, et al. A randomized study of direct coronary stent delivery compared with stenting after predilatation: the NIR Future Trial. Cathet Cardiovasc Intervent, 2000, 50(4): 377-381.
6.	Kovar LI, Monrad ES, Sherman W, et al. A randomized trial of stenting with or without balloon predilatation for the treatment of coronary artery disease. Am Heart J, 2001, 142(5): E9.
7.	Carrie D, Khalife K, Citron B, et al. for the BET Study Group. Comparison of direct coronary stenting with and without balloon predilatation in patients with stable angina pectoris. Am J Cardiol, 2001, 87(6): 693-698.
8.	Baim DS, Flatley M, Caputo R, et al. Comparison of PRE-dilatation vs Direct stenting In Coronary Treatment using the Medtronic AVE S670 coronary stent system (the PREDICT Trial). Am J Cardiol, 2001, 88(12): 1364-1369.
9.	Le Breton H, Boschat J, Commeau P, et al. for the Stent Without Balloon Predilatation (SWIBAP) Study Group.Randomised comparison of coronary stenting with and without balloon predilatation in selected patients. Heart, 2001, 86(3): 302-308.
10.	Brito FS, Caixeta AM, Perin MA, et al, on behalf of the DIRECT Study Investigators. Comparison of direct stenting versus stenting with predilation for the treatment of selected coronary narrowings. Am J Cardiol, 2002, 89(2): 115-120.
11.	Loubeyre C, Morice MC, Lefe ´vre T, et al. A randomized comparison of direct stenting with conventional stent implantation in selected patients with acute myocardial infarction. J Am Coll Cardiol, 2002, 39(1): 15-21.
12.	Martinez-Elbal L, Ruiz-Nodar JM, Zueco J, et al, for the DISCO Investigators. Direct coronary stenting versus stenting with balloon pre-dilation: immediate and follow-up results of a multicentre, prospective,randomized study. The DISCO trial. DIrect Stenting of COronary Arteries. Eur Heart J, 2002, 23(8): 633-640.
13.	Sabatier R, Hamon M, Zhao QM, et al. Could direct stenting reduce no-reflow in acute coronary syndromes? A randomized pilot study. Am Heart J, 2002, 143(6): 1027-1032.
14.	Brueck M, Scheinert D, Wortmann A, et al. Direct Coronary Stenting Versus Predilatation Followed by Stent Placement. Am J Cardiol, 2002, 90(11): 1187-1192.
15.	Ballarino MA, Moreyra E, Damonte A, et al. Multicenter Randomized Comparison of Direct vs.Conventional Stenting: The DIRECTO Trial. Cathet Cardiovasc Intervent, 2003, 58(4): 434-440.
16.	Airoldi F, Mario CD, Gimelli G, et al. A Randomized Comparison of Direct Stenting Versus Stenting With Predilatation in Native Coronary Artery Disease: Results from the Multicenter CROSSCUT Study. J Invas Cardiol, 2003, 15(1): 1-5.
17.	Ijsselmuiden AJJ, Serruys PW, Scholte A, et al. Direct coronary stent implantation does not reduce the incidence of in-stent restenosis or major adverse cardiac events. Eur Heart J, 2003, 24(): 421-429.
18.	Hoffmann R, Takimoglu-Boerekci M, Langenberg R, et al. Randomized comparison of direct stenting with predilatation followed by stenting on vessel trauma and restenosis. Am Heart J, 2004, 147(4): E13.
19.	López-Palop R, Pinar E, Lozano Í, et al. Comparison of Intracoronary Ultrasound Expansion Parameters in Coronary Stents Implanted With or Without Balloon Predilatation. A Randomized Intravascular Ultrasound Study. Rev Esp Cardiol, 2004, 57(5): 403-411.
20.	Mehilli J, Kastrati A, Dirschinger J, et al. Intracoronary Stenting and Angiographic Results: Restenosis After Direct Stenting Versus Stenting With Predilation in Patients With Symptomatic Coronary Artery Disease (ISAR-DIRECT Trial). Cathet Cardiovasc Intervent, 2004, 61(2): 190-195.
21.	Balachandran KP, Singh B, Sandilands A, et al. Functional result following direct coronary artery stenting with drug eluting stents in chronic stable angina is similar to stenting after balloon predilatation. International Journal of Cardiology, 2008, 128(3): 374-377.
22.	Wijns W, Verheye S, Manoharan G, et al. Angiographic, intravascular ultrasound, and fractional flow reserve evaluation of direct stenting vs. conventional stenting using BeStent2 in a multicentre randomized trial. Eur Heart J, 2005, 26(18): 1852-1859.
23.	Dawkins KD, Chevalier B, Suttorp MJ, et al. Effectiveness of “Direct” Stenting Without Balloon Predilatation (from the Multilink Tetra Randomised European Direct Stent Study [TRENDS]). Am J Cardiol, 2006, 97(3): 316-321.
24.	Ozdemir R, Sezgin AT, Barutcu I, et al. Comparison of Direct Stenting Versus Conventional Stent Implantation on Blood Flow in Patients With ST-Segment Elevation Myocardial Infarction. Angiology, 2006, 57(4): 453-458.
25.	Gasior M, Gierlotka M, Lekston A, et al. Comparison of Outcomes of Direct Stenting Versus Stenting After Balloon Predilation in Patients With Acute Myocardial Infarction (DIRAMI). Am J Cardiol, 2007, 100(5): 798-805.
26.	Cuisset THamilos M, Melikian N, et al. Direct Stenting for Stable Angina Pectoris Is Associated With Reduced Periprocedural Microcirculatory Injury Compared With Stenting After Pre-Dilation. J Am Coll Cardiol, 2008, 51(11): 1060-1065.
27.	刘晓堃, 傅向华. 直接冠状动脉内支架术与球囊预扩张后支架术的对比研究. 中国综合临床, 2002, 18(10): 890.
28.	中国卫生部. 2008年我国公共卫生事业发展公报. 2009.
29.	周玉杰. 支架血栓2009: 现状与展望. Available at: http://med.haoyisheng.com/09/1028/310046724.html.
30.	Rogers C, Parikh S, Seifert P, et al. Endogenous cell seeding: remnant endothelium after stenting enhances vascular repair. Circulation, 1996, 94(11): 2909-2914.

1. 陆再英, 钟南山, 等. 内科学(第7版). 人民卫生出版社, 2008: 272.
2. 颜红兵, 朱小玲, 高海. 冠心病介入治疗临床随机试验. 中国环境科学出版社, 2005: 简介.
3. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions: version 5.0.1 Cochrane Collaboration, 2008.
4. Danzi GB, Capuano C, Fiocca L, et al. Stent implantation in patients with a single, noncalcified coronary artery lesion. Am J Cardiol, 1999, 84(10): 1250-1253.
5. Ormiston JA, Webster MWI, Ruygrok PN, et al. A randomized study of direct coronary stent delivery compared with stenting after predilatation: the NIR Future Trial. Cathet Cardiovasc Intervent, 2000, 50(4): 377-381.
6. Kovar LI, Monrad ES, Sherman W, et al. A randomized trial of stenting with or without balloon predilatation for the treatment of coronary artery disease. Am Heart J, 2001, 142(5): E9.
7. Carrie D, Khalife K, Citron B, et al. for the BET Study Group. Comparison of direct coronary stenting with and without balloon predilatation in patients with stable angina pectoris. Am J Cardiol, 2001, 87(6): 693-698.
8. Baim DS, Flatley M, Caputo R, et al. Comparison of PRE-dilatation vs Direct stenting In Coronary Treatment using the Medtronic AVE S670 coronary stent system (the PREDICT Trial). Am J Cardiol, 2001, 88(12): 1364-1369.
9. Le Breton H, Boschat J, Commeau P, et al. for the Stent Without Balloon Predilatation (SWIBAP) Study Group.Randomised comparison of coronary stenting with and without balloon predilatation in selected patients. Heart, 2001, 86(3): 302-308.
10. Brito FS, Caixeta AM, Perin MA, et al, on behalf of the DIRECT Study Investigators. Comparison of direct stenting versus stenting with predilation for the treatment of selected coronary narrowings. Am J Cardiol, 2002, 89(2): 115-120.
11. Loubeyre C, Morice MC, Lefe ´vre T, et al. A randomized comparison of direct stenting with conventional stent implantation in selected patients with acute myocardial infarction. J Am Coll Cardiol, 2002, 39(1): 15-21.
12. Martinez-Elbal L, Ruiz-Nodar JM, Zueco J, et al, for the DISCO Investigators. Direct coronary stenting versus stenting with balloon pre-dilation: immediate and follow-up results of a multicentre, prospective,randomized study. The DISCO trial. DIrect Stenting of COronary Arteries. Eur Heart J, 2002, 23(8): 633-640.
13. Sabatier R, Hamon M, Zhao QM, et al. Could direct stenting reduce no-reflow in acute coronary syndromes? A randomized pilot study. Am Heart J, 2002, 143(6): 1027-1032.
14. Brueck M, Scheinert D, Wortmann A, et al. Direct Coronary Stenting Versus Predilatation Followed by Stent Placement. Am J Cardiol, 2002, 90(11): 1187-1192.
15. Ballarino MA, Moreyra E, Damonte A, et al. Multicenter Randomized Comparison of Direct vs.Conventional Stenting: The DIRECTO Trial. Cathet Cardiovasc Intervent, 2003, 58(4): 434-440.
16. Airoldi F, Mario CD, Gimelli G, et al. A Randomized Comparison of Direct Stenting Versus Stenting With Predilatation in Native Coronary Artery Disease: Results from the Multicenter CROSSCUT Study. J Invas Cardiol, 2003, 15(1): 1-5.
17. Ijsselmuiden AJJ, Serruys PW, Scholte A, et al. Direct coronary stent implantation does not reduce the incidence of in-stent restenosis or major adverse cardiac events. Eur Heart J, 2003, 24(): 421-429.
18. Hoffmann R, Takimoglu-Boerekci M, Langenberg R, et al. Randomized comparison of direct stenting with predilatation followed by stenting on vessel trauma and restenosis. Am Heart J, 2004, 147(4): E13.
19. López-Palop R, Pinar E, Lozano Í, et al. Comparison of Intracoronary Ultrasound Expansion Parameters in Coronary Stents Implanted With or Without Balloon Predilatation. A Randomized Intravascular Ultrasound Study. Rev Esp Cardiol, 2004, 57(5): 403-411.
20. Mehilli J, Kastrati A, Dirschinger J, et al. Intracoronary Stenting and Angiographic Results: Restenosis After Direct Stenting Versus Stenting With Predilation in Patients With Symptomatic Coronary Artery Disease (ISAR-DIRECT Trial). Cathet Cardiovasc Intervent, 2004, 61(2): 190-195.
21. Balachandran KP, Singh B, Sandilands A, et al. Functional result following direct coronary artery stenting with drug eluting stents in chronic stable angina is similar to stenting after balloon predilatation. International Journal of Cardiology, 2008, 128(3): 374-377.
22. Wijns W, Verheye S, Manoharan G, et al. Angiographic, intravascular ultrasound, and fractional flow reserve evaluation of direct stenting vs. conventional stenting using BeStent2 in a multicentre randomized trial. Eur Heart J, 2005, 26(18): 1852-1859.
23. Dawkins KD, Chevalier B, Suttorp MJ, et al. Effectiveness of “Direct” Stenting Without Balloon Predilatation (from the Multilink Tetra Randomised European Direct Stent Study [TRENDS]). Am J Cardiol, 2006, 97(3): 316-321.
24. Ozdemir R, Sezgin AT, Barutcu I, et al. Comparison of Direct Stenting Versus Conventional Stent Implantation on Blood Flow in Patients With ST-Segment Elevation Myocardial Infarction. Angiology, 2006, 57(4): 453-458.
25. Gasior M, Gierlotka M, Lekston A, et al. Comparison of Outcomes of Direct Stenting Versus Stenting After Balloon Predilation in Patients With Acute Myocardial Infarction (DIRAMI). Am J Cardiol, 2007, 100(5): 798-805.
26. Cuisset THamilos M, Melikian N, et al. Direct Stenting for Stable Angina Pectoris Is Associated With Reduced Periprocedural Microcirculatory Injury Compared With Stenting After Pre-Dilation. J Am Coll Cardiol, 2008, 51(11): 1060-1065.
27. 刘晓堃, 傅向华. 直接冠状动脉内支架术与球囊预扩张后支架术的对比研究. 中国综合临床, 2002, 18(10): 890.
28. 中国卫生部. 2008年我国公共卫生事业发展公报. 2009.
29. 周玉杰. 支架血栓2009: 现状与展望. Available at: http://med.haoyisheng.com/09/1028/310046724.html.
30. Rogers C, Parikh S, Seifert P, et al. Endogenous cell seeding: remnant endothelium after stenting enhances vascular repair. Circulation, 1996, 94(11): 2909-2914.

Chinese Journal of Evidence-Based Medicine

Direct Coronary Stenting vs. Conventional Stenting in Treating Coronary Heart Disease: A Meta-Analysis

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