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Clinical impact of undersized- versus oversized-stenting approaches in ST-elevation myocardial infarction

Sakura Nagumo1, Kohei Wakabayashi1, Miki Tsujiuchi1

  • 1Division of Cardiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba district, Yokohama city, Kanagawa prefecture, Japan, 227-8501.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|May 11, 2016
PubMed

Insights

Oversized stenting during percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) increases ST re-elevation and myocardial damage. An undersized-stenting approach may improve outcomes by reducing these risks.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Primary percutaneous coronary intervention (PCI) is standard for ST-elevation myocardial infarction (STEMI).
  • ST re-elevation during PCI can lead to further myocardial damage and poor outcomes.
  • An undersized-stenting strategy may mitigate ST re-elevation.

Purpose of the Study:

  • To investigate the association between final stent area and ST re-elevation during primary PCI in STEMI patients.
  • To evaluate the impact of stent size relative to reference vessel dimensions on procedural outcomes.

Main Methods:

  • 102 STEMI patients undergoing primary PCI with intravascular ultrasound guidance were analyzed.
  • Patients were categorized into undersized (stent-reference ratio < 1.0) and oversized (stent-reference ratio ≥ 1.0) groups.
  • Incidences of ST re-elevation and total ST resolution (STR) were compared between groups.

Main Results:

  • The oversized group had significantly higher ST re-elevation (32.5% vs. 9.7%) and lower total STR (22.4% vs. 43.4%).
  • Oversized stenting was independently associated with ST re-elevation (OR: 3.74, p=0.02).
  • Higher peak creatine kinase-MB levels were observed in the oversize group, indicating greater myocardial damage.

Conclusions:

  • An oversized-stenting approach in STEMI patients is linked to increased ST re-elevation and reduced ST resolution.
  • This approach results in greater myocardial damage compared to appropriate or undersized stenting.
  • Findings suggest that optimizing stent size is crucial for improving outcomes in primary PCI for STEMI.
Abstract

Keywords:
Intravascular ultrasoundPrimary percutaneous coronary interventionST-elevation myocardial infarctionUndersized-stenting approach

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