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Published on: February 18, 2020
[Direct stent implantation in acute myocardial infarction. The DISCO 3 study]
Carlos Cuellas1, Felipe Fernández-Vázquez, Ginés Martínez
1Servicio de Cardiología, Hospital de León, España. ccuellas@secardiologia.es
Insights
Direct stenting is feasible in over half of acute myocardial infarction patients, improving reperfusion without increasing adverse events. Key factors for direct stenting include early presentation and initial blood flow.
Area of Science:
- Interventional Cardiology
- Acute Myocardial Infarction Management
- Percutaneous Coronary Intervention
Background:
- Direct stenting in primary angioplasty is associated with reduced no-reflow phenomenon and distal embolization.
- The clinical utility and patient selection criteria for direct stenting in acute myocardial infarction (AMI) require further elucidation.
Purpose of the Study:
- To determine the proportion of AMI patients suitable for direct stent implantation.
- To identify predictors for successful direct stenting in AMI.
- To evaluate the impact of direct stenting versus predilatation on reperfusion and clinical outcomes.
Main Methods:
- Prospective, descriptive, multicenter study (DISCO 3) involving 189 AMI patients.
- Assessment of angiographic reperfusion parameters and ST-segment resolution.
- Recording of adverse clinical events at discharge, and at 1 and 6 months.
Main Results:
- Direct stenting was performed in 56% of patients; predilatation in 44%.
- Predictors for direct stenting included short postinfarction delay, non-zero initial TIMI flow, and preinfarction angina.
- Direct stenting showed superior myocardial reperfusion: 84% vs 69% TIMI myocardial perfusion grade 2-3 (P=.005) and 66% vs 42% >70% ST-segment resolution (P=.003).
Conclusions:
- Direct stenting is a feasible strategy in over half of AMI patients.
- Contraindications include severely calcified lesions, tortuous vessels, and occluded guidewire passage.
- Improved myocardial reperfusion was observed with direct stenting, with no significant difference in adverse clinical events.
Introduction And Objectives:
An association has been reported between direct stenting in primary angioplasty and low incidences of the no-reflow phenomenon and distal embolization. The aims of this study were to determine the proportion of patients who can be treated by direct stent implantation and to identify factors that establish when the technique should be used in acute myocardial infarction in clinical practice.
Patients And Method:
This prospective descriptive and multicenter study (DISCO 3) included 189 patients. Angiographic reperfusion parameters were recorded and resolution of the ST-segment elevation was monitored. Adverse clinical events, such as death, non-fatal reinfarction and repeat revascularization of the culprit vessel, were recorded at discharge, and after one and six months.
Results:
Direct stenting was performed in 56% of patients, and stenting after predilatation in 44%. The main predictors of direct stenting were short postinfarction delay, non-zero initial TIMI flow, and preinfarction angina. The most common reasons for balloon predilatation were TIMI flow zero on traversing the lesion with a guidewire (92%), involvement of a major bifurcation or tortuous vessel, and severe calcification. Indices of myocardial reperfusion were better with direct stenting: TIMI myocardial perfusion grade 2-3 flow was present in 84% vs 69% (P=.005), and > 70% ST-segment resolution occurred in 66% vs 42% (P=.003). No difference in adverse clinical events was found.
Conclusions:
Direct stenting is feasible for treating acute myocardial infarction in more than half of patients. The lesions should not be severely calcified nor involve tortuous vessels, and there should be sufficient flow following passage of a guidewire to define the lesion's characteristics.
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