792-2.Is the Anti-Restenosis Effect of Stent (vs PTCA) Greater in LAD Vessels? A Subgroup Analysis of the STent REStenosis Study

In the multicenter randomized STent REStenosis Study (STRESS), stent (S) implantation has shown to reduce restenosis (RES) by 26% compared with PTCA. To determine the impact of Svs PTCA in reducing RES in various vessel locations, we analyzed the data from STRESS in LAD and non-LAD vessels.LAD PTCA N=98LAD S N=96Non-LAD PTCA N=104Non-LAD S N=109Final % stenosis34±1517±11†35±1420±12†Acute gain (mm)1.14±0.471.62±0.43†1.32±0.491.81±0.47†Late Loss (mm)0.52±0.550.78±0.57*0.34±0.570.73±0.57†Net gain (mm)0.59±0.550.88±0.62*1.03±0.611.06±0.61RES (>50% stenosIs)52.632.9*29.929.5*.p≤0.01†.p≤0.0001 compared S with PTCAIn both LAD and non-LAD vessels, S (compared with PTCA) achieved a greater acute ga in and resulted in a lower final % stenosis. Late loss was also greater in S than PTCA group and similar for LAD and non-LAD vessels. However, in PTCA pts, late loss was much lower in non-LAD vessels (vs LAD). Thus, the overall net gain and RES in non-LAD vessels were similar for S.and PTCA, whereas the net gain was greater after S in LAD vessels and resulted in much lower RES compared with PTCA. Similarly, the difference in eventfree survival (freedom from death, MI, CABG, or repeat PTCA) between S and PTCA was greater in LAD (77% vs 66%, P=0.06) than non-LAD vessels (78% vs 72%, NS).In ConclusionSTRESS substudy analysis indicates 1) S provides uniformly greater improvement of angiographic results in all lesion locations compared with PTCA, 2) much greater anti-restenosis and clinical benefits in S pts within the LAD vessels, and 3) more aggressive post-S dilatation strategies (to further reduce final % stenosis) are recommended for non-LAD vessels to achieve greater differential anti-restenosis benefit for S