November 1, 2013 — A new study showed that a conservative approach to revascularization for patients with intermediate coronary lesions determined by angiographic diameter stenosis is safe and non-inferior to an aggressive approach. Findings of the SMART-CASE trial were presented at the 25th annual Transcatheter Cardiovascular Therapeutics scientific symposium (TCT 2013).
The SMART-CASE trial evaluated the relative efficacy and safety of a conservative revascularization strategy for intermediate stenoses compared to a more aggressive approach of anatomical complete revascularization in the treatment of coronary stenosis. The investigator-initiated, multicenter, open label, prospective trial randomized 899 patients undergoing coronary angiography to be evaluated for percutaneous coronary intervention (PCI) based on a conservative strategy (revascularization of DS > 70 percent) or an aggressive strategy (DS > 50 percent). The primary endpoint was a composite of all-cause death, myocardial infarction or any revascularization at one year.
After one year, both the conservative strategy group and aggressive strategy group had similar rates of adverse events (7.3 percent versus 6.8 percent, respectively). Rates for all cause death (0.5 percent versus 2.1 percent), myocardial infarction (0.9 percent in each group) and any revascularization (6.8 percent versus 4.8 percent) were also similar, demonstrating the non-inferiority of the conservative strategy.
“Conservative revascularization using criteria of 70 percent diameter stenosis was found to be non-inferior to aggressive revascularization,” said Hyeon-Cheol Gwon, M.D., Ph.D., professor, Samsung Medical Center in Seoul, South Korea and lead investigator of the study.
“These results demonstrate that revascularization of angiographically intermediate lesions can be safely deferred.”
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November 12, 2025 
