Outcomes of direct stenting in patients with ST-elevated myocardial infarction

• Published in: Herz 2018-08, Vol.43 (5), p.447-454
• Main Authors: Kalayci, A., Oduncu, V., Karabay, C. Y., Erkol, A., Tanalp, A. C., Tanboga, I. H., Candan, O., Gecmen, C., Izgi, I. A., Kirma, C.
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon, Coronary; Cardiology; Coronary Angiography; Electrocardiography; Embolization; Female; Heart; Heart attacks; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Microcirculation; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - therapy; Original Articles; Patients; Percutaneous Coronary Intervention; Quality; Reperfusion; Reproducibility of Results; Retrospective Studies; Risk analysis; Risk factors; Stents; Survival; Survival analysis; Thrombolysis; Treatment Outcome; Ventricle
• ISSN: 0340-9937; 1615-6692
• DOI: 10.1007/s00059-017-4581-2

Background We compared direct stenting (DS) with conventional stenting (CS) – i.e., stenting after predilation – during primary percutaneous coronary intervention (P-PCI) in terms of procedural results and long-term mortality in patients with ST-elevated myocardial infarction (STEMI). Methods We retrospectively analyzed 2306 patients (mean age 59 years, 22% female) who underwent P‑PCI within 12 h of symptom onset. Patients were then followed up prospectively for clinical events. Patients were divided into a DS group ( n  = 597) and a CS group ( n  = 1709). The CS group was further divided into a CS-1 group (baseline thrombolysis in myocardial infarction [TIMI] flow grade ≥ 1) and a CS-2 group (baseline TIMI flow grade 0). Main outcome measures were postprocedural myocardial reperfusion and all-cause mortality in long-term follow-up. Results Patients in the DS group had a higher percentage of final TIMI-3 flow, myocardial blush grade 3 and complete ST-segment resolution, better left ventricular ejection fraction, and a lower incidence of distal embolization compared with CS patients. In-hospital (1.5 vs. 4.6%, respectively, p  = 0.001) and long-term all-cause mortality (8.8 vs. 17.0%, respectively, p  < 0.001) were significantly lower in the DS group than in the CS group. Kaplan–Meier survival analysis showed similar survival rates in the DS and CS-1 groups (log-rank p  = 0.40), but significantly worse survival in the CS-2 group than in the other groups (log-rank p  < 0.001). After adjusting for risk factors, DS was not found to be a predictor of long-term mortality. Conclusion DS in P‑PCI was associated with better postprocedural angiographic results and long-term survival. However, the DS group had similar in-hospital and long-term mortality to matched patients in the CS group.