Published Online
on March 3, 2003

A more recent version of this article appeared on March 11, 2003

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Submitted on November 11, 2002
Accepted on December 3, 2002

Heparin-Coated Stent Placement for the Treatment of Stenoses in Small Coronary Arteries of Symptomatic Patients

Michael Haude MD^*, Thomas F.M. Konorza MD, Uldis Kalnins MD, Andrejs Erglis MD, Kari Saunamäki MD, Helmut D. Glogar MD, Eberhard Grube MD, Robert Gil MD, Antonio Serra MD, Hans G. Richardt MD, Peter Sick MD, Raimund Erbel MD, and for the heparin-COAted STents in small coronary arteries (COAST) Trial Investigators

From the Cardiology Clinic, University Essen (M.H., T.F.M.K., R.E.), Essen, Germany; P. Stradins University Hospital (U.K., A.E.), Riga, Latvia; Rigshospitalet/Hjertecentret (K.S.), Copenhagen, Denmark; Allgemeines KrankenHaus Wien (H.D.G.), Vienna, Austria; Krankenhaus Siegburg GmbH (E.G.), Siegburg, Germany; Pomorskiej Akademii Medycznej Hemodynamiki I Elektrofizjologii (R.G.), Szczecin, Poland; Hospital Clinic I Provincial Servicio Hemodinamica Cardiaca (A.S.), Barcelona, Spain; Cardiology Department, University Lübeck (H.G.R.), Lübeck, Germany; and University Leipzig, Heart Center GmbH (P.S.), Leipzig, Germany.

^* To whom correspondence should be addressed. E-mail: michael.haude{at}uni-essen.de.

Background--The role of stents, especially of heparin-coated stents for the treatment of stenoses in small coronary arteries, is still unclear. Therefore, we performed this prospective, randomized trial to evaluate the angiographic and clinical outcome after treatment of stenoses in small coronary arteries (2.0 to 2.6 mm) of symptomatic patients.

Methods and Results--We randomly assigned 588 patients to angioplasty (n=195), bare stenting (n=196), or heparin-coated stenting (n=197). The primary end point was minimal lumen diameter (MLD) at 6 months. With comparable baseline parameters, the two stent arms showed a larger postinterventional MLD, larger acute gain, and smaller residual percent diameter stenosis, although a residual stenosis of 12±16% was achieved in the angioplasty arm, including a 27% crossover rate to stenting. Eighty percent of patients had follow-up angiography, which documented a borderline significantly larger MLD and smaller percent diameter stenosis for the two stent groups (1.34±0.48 mm and 42±20% after angioplasty, 1.47±0.48 mm and 36±20% after bare stenting, and 1.45±0.54 mm and 38±23% after heparin-coated stenting; P=0.049 and P=0.038, respectively), but restenosis rates were not different (32%, 25%, and 30%). Thrombotic events occurred in 1.0% after angioplasty and 0.5% after bare or heparin-coated stenting. Survival without myocardial infarction or target vessel revascularization at 250 days was 84.6% (angioplasty), 88.3% (bare stenting), and 88.3% (heparin-coated stenting; log-rank P=0.39).

Conclusion--Compared with angioplasty with provisional stenting, bare and heparin-coated stenting confer superior angiographic results and a nonsignificant 24% reduction in clinical events, with no difference between bare and heparin-coated stenting in the treatment of stenoses in small coronary arteries.

Key words: stents • angioplasty • heparin • restenosis

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