Direct stent implantation in acute coronary syndrome

To evaluate the feasibility and safety of direct stenting and to compare it with conventional implantation techniques in patients with acute coronary syndrome (ACS).

A total of 145 patients were divided into two arms based on the stenting technique used: group I (n = 71) = direct stenting without predilatation group that included only single-vessel procedures and group II (n = 74) = stenting with predilatation group that included only single-vessel conventional stent implantations. The primary endpoint of the study was the major adverse clinical event (MACE) rate in-hospital, at 1 month, and at 6 months and the secondary endpoint was the balloon inflation time (BIT), the number of balloon inflations (NBI), the radiation exposure time (RET), the amount of contrast dye used (ACD) and the no-reflow phenomenon.

Primary success rate was 89% in group I and 95% in group II; overall procedural success rate was 94% in group I and 100% in group II. The rate of MACE was not different during the follow-up period between the two groups. The RET, BIT and NBI were significantly lower in group I than in group II (p < 0.001 for all). The ACD used was also significantly lower in group I than in group II (125 60 ml versus 155 71 ml; p = 0.006). Furthermore, the rate of no-reflow was significantly lower in group I than in group II (2.8% versus 13.5%; p = 0.03).

Direct stenting is a feasible and safe technique. It is equivalent to single-vessel conventional stent implantation techniques with respect to MACE rate in-hospital, at 1 month, and at 6 month follow-up in selected patients with ACS.