Changes in reference vessel diameter in ST-segment elevation myocardial infarction after primary percutaneous...

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Stent undersizing during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) may increase stent thrombosis.
• Reference vessel diameter (RVD) is a critical factor in stent selection and outcomes.

Purpose of the Study:

• To compare RVD of the infarct-related artery before, immediately after, and at late follow-up after PCI for STEMI.
• To investigate differences in RVD behavior between paclitaxel-eluting stents (PES) and bare-metal stents (BMS) at follow-up.

Main Methods:

• Analysis of quantitative angiographic data from 2,974 patients (3,589 lesions) in the HORIZONS-AMI trial.
• Comparison of RVD at baseline, post-PCI, and 13-month follow-up for lesions treated with PES (2,233) and BMS (741).

Main Results:

• Median RVD was stable: 2.87 mm (baseline), 2.92 mm (post-PCI), and 2.88 mm (follow-up).
• No significant differences in RVD were observed between PES and BMS groups at any time point.
• RVD at baseline and post-PCI was similar in patients with and without stent thrombosis.

Conclusions:

• Reference vessel diameter does not significantly change from baseline to follow-up after PCI for STEMI.
• Stent sizing appears appropriate for vessel size, and stent type does not influence RVD changes.
• Stent undersizing is unlikely to be the primary driver of high stent thrombosis rates in STEMI.