Optimal Angioplasty vs Primary Stenting - OPUS Trial

	March 7, 1999 - Despite the frequent use of angioplasty 
with stents, it is unclear if typical coronary artery lesions 
should routinely get a stent. Stents are easy to use and have a 
lower restenosis rate, but have problems: difficulty treating 
in-stent restenosis when it happens, higher cost, and increased 
restenosis in certain sized lesions. Simple balloon angioplasty 
allows treatment of restenosis, and better success in difficult 
sized lesions, but there is a higher rate of restenosis.
	Douglas Weaver from Henry Ford Hospital in Detroit 
report their findings from the Optimal Angioplasty versus 
Primary Stenting (OPUS) Trial. They studied whether routine 
stenting in all angioplasty patients would decrease death, 
cardiovascular events, and cost, compared to angioplasty with 
stenting only when necessary.
	All patients got aspirin and ticlopidine. Abciximab 
(Reopro) and intravascular ultrasound were both permitted. 
The Palmaz-Schatz stent was most frequently used, although 
other models could be chosen.
	479 patients with angina, ischemia, or recent heart attack 
were enrolled in 2 groups: routine stenting for 230 patients versus
balloon angioplasty with stenting-only-when-necessary for 249 
patients. Average age was 61 years with 75% of the patients 
being men. 44% had a previous heart attack and 18% were diabetics. 
The EF averaged 60%. Necessary stenting occurred in 37% of the
angioplasty group. Abciximab was used in only 13% of all patients.
Primary outcome was combined cardiovascular events. Secondary 
outcome was death, heart attack, need for revascularization, and 
cost. The events were measured at 6 months.
	Primary outcome - combined cardiovascular events
(death, heart attack or need for revascularization) at 6 months -
showed significant benefit for the routinely stented group (6.1%) 
compared to the stented-only-when-necessary group (14.9%). 
	Secondary outcome - need for revascularization, and 
cost - also showed a significant advantage for the routinely 
stented group (4% and $10,206) compared to the 
only-when-necessary-stented group (10% and $10,490).
	CONCLUSION: The OPUS trial found that cardiovascular 
events and cost are reduced when routine stenting is the first
approach to angioplasty.