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Direct stenting may limit myocardial injury during percutaneous coronary intervention
Thuraia Nageh1, Martyn R Thomas, Roy A Sherwood
1King s College Hospital, Denmark, London, England, United Kingdom. tnageh@hotmail.com
Insights
Direct stenting reduces cardiac troponin I release and major adverse cardiac events compared to balloon predilatation. This percutaneous coronary intervention technique offers improved patient outcomes and safety.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- Direct stenting (DS) is a safe and feasible percutaneous coronary intervention (PCI) with reduced costs, time, and radiation exposure.
- DS may limit distal embolization, potentially reducing myocardial injury and improving prognosis after PCI.
Purpose of the Study:
- To compare cardiac troponin I (cTnI) release and major adverse cardiac events (MACE) between direct stenting (DS) and stenting with balloon predilatation (PD).
Main Methods:
- A total of 311 patients (440 vessels/lesions) underwent either DS (n=107) or PD (n=204).
- Cardiac troponin I (cTnI) levels were measured post-procedure, and MACE were assessed at 6-18 month follow-up.
- Groups were matched for lesion site and complexity, with a higher proportion of diabetics in the PD group.
Main Results:
- Post-procedural peak cTnI concentrations were significantly lower in the DS group (0.2 ± 0.1 µg/L) compared to the PD group (0.5 ± 0.3 µg/L) (p=0.02).
- Elevated cTnI (>0.2 µg/L) occurred in 10% of DS patients versus 26% of PD patients (p<0.0001).
- The rate of MACE at 6-18 months was significantly lower in the DS group (8%) compared to the PD group (15%) (p=0.02).
Conclusions:
- Direct stenting without balloon predilatation is associated with reduced post-procedural myocardial injury, indicated by lower cTnI levels.
- DS demonstrates a lower incidence of major adverse events compared to traditional stenting with predilatation.
- These findings suggest direct stenting is a favorable approach for percutaneous coronary intervention.
Background:
Direct coronary stenting has been shown to be safe and feasible, with a demonstrable reduction in cost, procedural time and radiation exposure. Direct stenting may limit distal embolization of atherosclerotic plaque and consequently reduce myocardial cell injury following percutaneous coronary intervention, which may have important prognostic implications.
Methods And Results:
We assessed cardiac troponin I (cTnI) release in the 24 hours following direct coronary stenting (DS) as compared to stenting with balloon predilatation (PD) in a total of 311 patients and 440 vessels/lesions (vessel to lesion ratio = 1:1) (DS: n = 107 patients and 149 vessels/lesions; PD: n = 204 patients and 291 vessels/lesions). The 2 groups were well matched except for a greater proportion of diabetic patients in the PD group (21%) compared to the DS group (11%) (p < 0.05). There were no significant differences in the distribution of target lesion site or angiographic complexity between the 2 groups. Primary angiographic success was achieved in 97% of vessels in the DS group and 98% of vessels in the PD group (p = NS). DS failed in 7/114 patients (6%) deemed suitable for DS by the operator, but all stents were subsequently successfully deployed following balloon predilatation. Abciximab (ReoPro , Eli Lilly Company, Indianapolis, Indiana) was used in 11 patients (10%) in the DS group and 24 patients (12%) in the PD group ( p = 0.68). The post-procedural median (IQR) peak cTnI concentrations were 0.2 0.1 g/L in the DS group and 0.5 0.3 g/L in the PD group (p = 0.02). Post-procedural cTnI concentrations were > 0.2 g/L in 11 patients (10%) in the DS group and in 53 patients (26%) in the PD group (X2 = 58.6; p < 0.0001). The rate of major adverse cardiac events at 6 18 month follow-up was 8% in the DS group and 15% in the PD group (X2 = 38.5; p = 0.02).
Conclusion:
Direct stenting without balloon predilatation is associated with lower post-procedural cTnI concentrations and lower incidence of major adverse events compared to traditional stenting with predilatation.