Conventional versus direct stenting in AMI: effect on immediate coronary blood flow

There are no data regarding the potential benefits of direct stenting in the setting of AMI. The aim of this study was to evaluate the impact of direct stenting on the angiographic results and compare it to conventional stenting performed in the setting of AMI. We reviewed our institutional interventional database and identified 44 patients who had undergone stenting in the setting of AMI (29 primary and 15 rescue angioplasty). Patients were then divided into two groups; group A consisted of patients who had undergone conventional stenting (23 patients) and group B those who had undergone direct stenting (21 patients). Angiographic success was defined as TIMI flow grade 2. The baseline TIMI 0-1 flow was higher in group A compared to group B (74% vs. 24%; p < 0.05). TIMI flow rates before stenting (after balloon predilation in group A and after guidewire crossing in group B) and angiographic success (TIMI flow 2) after stenting were similar in both groups (p > 0.05). However, the final TIMI 3 flow were significantly better in group B after stenting (65% vs. 95%; p < 0.05). Although there was no no re-flow in group B, three patients in group A had no re-flow after balloon predilatation of lesions with baseline TIMI 2 flow. There was a statistical tendency to a higher TIMI 3 flow in patients treated with direct stenting in the setting of AMI. Direct stenting strategy in thrombus containing lesions seems to be a safe and feasible approach in avoiding no re-flow.