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Coronary vessel diameters during and after primary percutaneous coronary artery intervention
1Cardiology Department, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
Insights
Delayed stent implantation after primary percutaneous coronary intervention (P-PCI) for acute myocardial infarction (AMI) allows for larger reference vessel diameter (RVD) and may reduce complications. This finding supports a brief delay for optimal stent selection.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Primary percutaneous coronary intervention (P-PCI) is the standard for acute coronary syndromes.
- Coronary vasoconstriction is common during acute myocardial infarction (AMI) due to elevated catecholamines.
- Reference vessel diameter (RVD) changes in the infarct-related artery (IRA) post-P-PCI are not fully understood.
Purpose of the Study:
- To compare the reference vessel diameter (RVD) of the infarct-related artery (IRA) during primary PCI and after a 3-day follow-up.
- To evaluate changes in vessel dimensions and stenosis after initial P-PCI in patients with ST-segment elevation myocardial infarction (STEMI).
Main Methods:
- Coronary angiography (CAG) was performed on 58 STEMI patients achieving TIMI 3 flow post-P-PCI.
- Measurements included lesion length, RVD, minimal lumen diameter (MLD), mean vessel diameter (meanD), and area of stenosis.
- Comparisons were made between measurements during P-PCI and at a follow-up CAG approximately 3 days later.
Main Results:
- RVD, MLD, and meanD were significantly larger at follow-up CAG compared to post-P-PCI (p < 0.002 for all).
- Area of stenosis was significantly lower at follow-up CAG (62.1% ± 15%) versus post-P-PCI (69.5% ± 16.5%, p=0.001).
- Lesion length showed no significant difference between the two time points (p > 0.05).
Conclusions:
- RVD is greater in the follow-up CAG a few days after AMI in patients with TIMI 3 flow post-P-PCI.
- A short delay in stent implantation during P-PCI may allow for the use of larger stents.
- This approach could potentially decrease rates of stent thrombosis and restenosis.
Background:
Primary percutaneous coronary intervention (P-PCI) is the gold standard treatment for acute coronary syndromes. Plasma levels of catecholamines and other vasopressors are elevated during acute myocardial infarction (AMI) and coronary vasoconstriction is frequent. We aimed to compare the reference vessel diameter (RVD) of the infarct-related artery (IRA) during primary PCI and after an average of 3 days.
Methods:
Coronary angiography (CAG) was performed on 58 patients with acute ST-segment elevation myocardial infarction (STEMI) and TIMI 3 flow after P-PCI (43 men, 15 women; mean age, 55.5 ± 10 years). TIMI 3 flow was achieved either by simple balloon dilatation and/or thrombus aspiration. Lesion length, RVD, minimal lumen diameter (MLD), mean vessel diameter (meanD), and area of stenosis were compared during P-PCI and follow-up CAG.
Results:
RVD, MLD, and meanD values were significantly higher during the follow-up CAG than after P-PCI (RVD 2.7 ± 0.7 mm vs. 2.9 ± 0.7 mm, p = 0.001; MLD 1.5 ± 0.5 mm vs. 1.7 ± 0.4 mm, p = 0.002; meanD 2.2 ± 0.5 mm vs. 2.4 ± 0.5 mm, p = 0.001). Area of stenosis values were significantly lower during the follow-up CAG than after primary PCI (69.5 ± 16.5 % vs. 62.1 ± 15 %, p = 0.001). Lesion lengths were not statistically significant during the follow-up CAG and primary PCI (lesion length 24.0 ± 10.8 mm vs. 22.1 ± 8.8 mm, p > 0.05).
Conclusion:
This study showed that RVD was higher at the follow-up CAG a few days after AMI in patients who had TIMI 3 flow after P-PCI with simple balloon dilatation and/or thrombus aspiration. A delay of a few days for stent implantation in P-PCI allows for larger-diameter stent use and may help to reduce stent thrombosis and restenosis rates.
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