A Meta-Analysis of Randomized Controlled Trials of Conventional Stenting Versus Direct Stenting in Patients With Acute Myocardial Infarction
Aiman Alak, Peter Lugomirski, Natasha Aleksova
1Department of Medicine, McMaster University, Rm. C3-118 DBCSVRI Building, Hamilton General, Hospital, 237 Barton St. East, Hamilton, Ontario, Canada, L8L 2X2. sanjit.jolly@phri.ca.
Insights
Direct stenting (DS) may reduce in-hospital cardiovascular death in acute myocardial infarction (AMI) patients compared to conventional stenting (CS). Further large trials are needed to confirm this potential benefit of DS in AMI treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Direct stenting (DS) is a technique used in percutaneous coronary intervention for acute myocardial infarction (AMI).
- No current guidelines recommend DS for AMI, despite its use to prevent distal embolization.
- This meta-analysis compares DS with conventional stenting (CS) in AMI patients.
Purpose of the Study:
- To compare the efficacy and safety of direct stenting (DS) versus conventional stenting (CS) in patients with acute myocardial infarction (AMI).
- To evaluate the impact of DS on key clinical outcomes including cardiovascular death, myocardial infarction, and revascularization.
Main Methods:
- A meta-analysis of randomized controlled trials (RCTs) was conducted.
- Studies were identified through comprehensive searches of EMBASE, MEDLINE, and Cochrane databases.
- The primary endpoint was death from cardiovascular causes, analyzed using a fixed effects model with Peto odds ratios.
Main Results:
- Five RCTs with 754 patients were included.
- Direct stenting showed a trend towards improved ST-segment resolution (OR, 1.51; P=.05).
- DS was associated with a significant reduction in in-hospital cardiovascular death (OR, 0.21; P=.02) with no significant difference in no-reflow, myocardial infarction, or target lesion revascularization.
Conclusions:
- Current small trials suggest a potential benefit of direct stenting in patients with acute myocardial infarction.
- Further large-scale randomized trials are necessary to definitively confirm the advantages of DS in AMI management.
Background:
Direct stenting (DS) is commonly used during percutaneous coronary intervention for acute myocardial infarction (AMI) to prevent distal embolization; however, no guideline recommendations exist regarding DS. We sought to compare DS with conventional stenting (CS) in patients presenting with AMI in a meta-analysis of randomized controlled trials.
Methods:
Studies were identified from EMBASE, MEDLINE, and Cochrane databases. To be included, randomized controlled trials must have compared DS with CS in patients with AMI. Data were extracted and articles were critically appraised by two authors. A fixed effects model was used, with Peto odds ratios (ORs). The primary endpoint was death from cardiovascular causes.
Results:
Five trials (n = 754) met the eligibility criteria. ST-segment resolution occurred in 68.9% (146/212) in the DS group vs 60.2% (127/211) in the CS group (OR, 1.51; 95% CI, 1.00-2.27; P=.05; I²=52%). No-reflow occurred in 6.6% in the DS group compared with 6.9% in the CS group (OR, 0.78; 95% CI, 0.39-1.55; P=.48; I²=0%). DS was associated with a significant reduction in the risk of in-hospital cardiovascular death (OR, 0.21; 95% CI, 0.06-0.77; P=.02; I²=0%). No significant differences were observed in myocardial infarction (OR, 0.38; 95% CI, 0.09-1.51; P=.17; I²=7%) or target lesion revascularization (OR, 1.20; 95% CI, 0.36-3.97; P=.76; I²=0%).
Conclusion:
Small trials suggest a potential benefit to DS in AMI. Further large-scale randomized trials are warranted to confirm the benefit of this approach.
