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Published on: May 28, 2019
Effects of direct stenting on epicardial and myocardial perfusion in patients with acute ST segment elevation
Mariusz Gasior1, Marek Gierlotka, Damian Pres
13rd Department and Division of Cardiology, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland. mariuszgasior@poczta.onet.pl
Insights
Direct stenting (DS) does not improve epicardial or myocardial patency in acute myocardial infarction (MI) patients compared to conventional stenting (CS). This randomized study found no significant differences in key perfusion metrics between the two stenting strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- Conflicting results exist regarding direct stenting (DS) versus conventional stenting (CS) in acute myocardial infarction (MI).
- Limited randomized studies address whether DS enhances epicardial and myocardial patency in acute MI patients.
Purpose of the Study:
- To evaluate the impact of DS on epicardial and myocardial patency in patients experiencing acute MI.
- To compare the effectiveness of DS against CS in improving coronary blood flow and tissue perfusion.
Main Methods:
- Randomized trial comparing DS and CS strategies in consecutive acute MI patients.
- Epicardial patency assessed via TIMI scale; myocardial patency via TIMI myocardial perfusion grade (TMPG) scale.
- ST segment resolution on ECG analyzed before and 30 minutes post-PCI.
Main Results:
- No significant differences in initial or final TIMI and TMPG scores between DS and CS groups.
- Comparable rates of no-reflow phenomenon and ST segment resolution (>50%) in both groups.
- DS group showed a trend towards lower rates of no-reflow and worsening patency, but not statistically significant.
Conclusions:
- Direct stenting does not offer significant advantages in improving epicardial and myocardial patency for unselected acute ST-elevation MI patients.
- Conventional stenting remains a viable and effective strategy for acute MI reperfusion.
Background:
Results of studies comparing direct stenting (DS) with conventional stenting (CS) after balloon predilatation in patients with acute myocardial infarction (MI) have been reported in the past, however they are conflicting. There are only few randomised studies that aim to answer whether DS improves epicardial and myocardial patency.
Aim:
To assess the effects of DS on epicardial and myocardial patency in patients with acute MI.
Methods:
Consecutive patients with acute MI were randomised either to DS or CS strategy. Clinical exclusion criteria were as follows: clinical and electrocardiographic features of reperfusion, pulmonary oedema, cardiogenic shock, contradictions to coronarography, allergy to aspirin, ticlopidine, clopidogrel, heparin and stainless steel. Angiographic exclusion criteria were as follows: lesion <50% with correct patency in the infarct-related artery (IRA), lesion in the left main coronary artery, previously performed percutaneous coronary intervention in the target vessel, diameter of the IRA <2 mm or >4 mm. We assessed epicardial patency according to the TIMI (thrombolysis in myocardial infarction) scale and myocardial patency according to the TMPG (TIMI myocardial perfusion grade) scale. In addition, we analysed ST segment resolution in 12-lead electrocardiography (ECG). The ECG was performed before and 30 minutes after PCI.
Results:
We analysed 300 consecutive patients with acute ST segment elevation MI. After exclusion of patients not suitable for the study design, the DS group comprised 110 patients and the CS group - 107 patients. Clinical and angiographic results were similar in both groups. Initial TIMI 0 (48.2% vs. 43.0%), initial TIMI 3 (31.8% vs. 28.0%), initial TMPG 0-1 (77.3% vs. 78.5%), final TIMI 3 (95.5% vs. 93.5%) and final TMPG 2-3 (68.2% vs. 60.8%) were similar in the DS and CS groups, respectively (p=NS). The incidence of no-reflow phenomenon was comparable in both groups (4.5% vs. 6.5%, NS). The inclusive rate of no-reflow phenomenon plus worsening patency in the IRA were 6.4% vs. 10.3% in the DS and CS groups respectively. The ST segment resolution > or = 50% was 58.1% in the DS group and 56.1% in the CS group (NS).
Conclusions:
Direct stenting does not significantly improve epicardial and myocardial patency in an unselected group of patients with acute ST segment elevation MI.
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