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Coronary artery disease| Volume 108, ISSUE 12, P1697-1703, December 15, 2011

Comparison of Direct Stenting With Conventional Stent Implantation in Acute Myocardial Infarction

Published:September 12, 2011DOI:https://doi.org/10.1016/j.amjcard.2011.07.040
Comparison of Direct Stenting With Conventional Stent Implantation in Acute Myocardial Infarction
Previous ArticlePrevalence of Dyssynchrony and Relation With Long-Term Outcome in Patients After Acute Myocardial Infarction
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      Small studies have suggested that direct stenting without balloon predilatation in ST-segment elevation myocardial infarction may reduce microcirculatory dysfunction. To examine the clinical benefits of direct stenting in a large cohort of patients who underwent primary percutaneous coronary intervention treated with contemporary pharmacotherapy, the 1-year outcomes from the multicenter, randomized Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial were analyzed. A total of 3,602 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were enrolled. The present study cohort consisted of 2,528 patients in whom single lesions (excluding bypass grafts) were treated with stent implantation. At operator discretion, direct stenting was attempted in 698 patients (27.6%), and stenting was performed after predilatation in 1,830 patients (72.4%). Propensity-score matching was performed to reduce bias. Direct stenting was successful in 677 patients (97.0%). ST-segment resolution at 60 minutes after the procedure was improved in patients who underwent direct compared to conventional stenting (median 74.8% vs 68.9%, respectively, p = 0.01). At 1-year follow-up, direct compared to conventional stenting was associated with a significantly lower rate of all-cause death (1.6% vs 3.8%, p = 0.01) and stroke (0.3% vs 1.1%, p = 0.049), with nonsignificant differences in target lesion revascularization, myocardial infarction, stent thrombosis, and major bleeding. Death at 1 year remained significantly lower in the direct stenting group after multivariate adjustment (hazard ratio 0.42, 95% confidence interval 0.21 to 0.86, p = 0.02) and in a propensity score–based analysis (hazard ratio 0.92, 95% confidence interval 0.88 to 0.95, p = 0.02). In conclusion, compared to stent implantation after predilatation, direct stenting is safe and effective in appropriately selected lesions in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention and may result in improved survival.
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      Article info

      Publication history

      Published online: September 12, 2011
      Accepted: July 15, 2011
      Received in revised form: July 15, 2011
      Received: April 17, 2011

      Identification

      DOI: https://doi.org/10.1016/j.amjcard.2011.07.040

      Copyright

      © 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

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