Short-term outcomes of balloon angioplasty versus stent placement for patients undergoing primary percutaneous coronary intervention: Implications for patients requiring early coronary artery bypass surgery

• Published in: The American heart journal 2013-06, Vol.165 (6), p.1000-1007
• Main Authors: Mehta, Rajendra H., MD, MS, Harjai, Kishore J., MD, MMM, Boura, Judy A., MS, Tcheng, James E., MD, Dixon, Simon R., MB.CHB, Stone, Gregg W., MD, Grines, Cindy L., MD
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty; Angioplasty, Balloon, Coronary - methods; Cardiovascular; Coronary Angiography; Coronary Artery Bypass - methods; Coronary vessels; Female; Follow-Up Studies; Heart attacks; Humans; Male; Middle Aged; Mortality; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Percutaneous Coronary Intervention; Retrospective Studies; Stents; Survival Rate - trends; Time Factors; Treatment Outcome; United States - epidemiology
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2013.03.006

Background In patients with acute ST-elevation myocardial infarction (STEMI) needing early coronary artery bypass graft (CABG) surgery, it is unknown whether primary percutaneous balloon angioplasty (PTCA)—without stent implantation—allows safe transition to subsequent CABG. Methods We examined acute STEMI patients enrolled in the Stent-PAMI and CADILLAC trials to study the differences in the early clinical events between those treated with primary PTCA (n = 1494) or primary stenting (n = 1488). Results Baseline clinical and pre- and post-procedural angiographic features including post-intervention TIMI 3 flow rates were similar in the 2 groups with the exception of higher median infarct-artery residual stenosis in the PTCA group (26% [IQR 19%-34%] vs. 18% [IQR 11-25%], P < .001]. Provisional stenting was required in 16% of patients in PTCA group, while stents could not be implanted in 2% of the stent group. Sixty-percent of PTCA patients had stent-like balloon result. The rate of 30-day ischemia-driven target vessel revascularization was higher in the PTCA group (4.3% vs. 2.0%, P < .001 [4.6% vs 2.3%, P < .001 among patients with multivessel disease and 3.4% vs. 2.0%, P = .044 in patients with stent-like balloon results]) while 30-day major adverse cardiac events (6.2% vs 4.9%), death (1.8% versus 2.8%), and reinfarction (0.9% vs. 0.7%) were similar in the 2 groups. Conclusions Compared with primary stenting, primary PTCA of infarct artery in STEMI patients was associated with significant increase in ischemia-driven target vessel revascularization (ITVR) rate, yet with no increased risk of major adverse cardiac events, reinfarction or death. Thus, provided close surveillance is maintained and prompt treatment initiated for early ischemic events, PTCA (particularly in those with stent-like balloon result) may be a reasonable and safe option in STEMI patients needing early CABG.