A novel stent inflation protocol improves long-term outcomes compared with rapid inflation/deflation deployment...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Coronary stent deployment commonly uses high-pressure inflation, but inflation duration is inconsistent and doesn't account for lesion compliance.
• A novel Pressure Optimization Protocol (POP) was developed for stent deployment, relying on inflation pressure stability instead of arbitrary time or visual balloon appearance.

Purpose of the Study:

• To evaluate the long-term effectiveness of the Pressure Optimization Protocol (POP) for coronary stent deployment compared to standard rapid inflation/deflation techniques.

Main Methods:

• A total of 792 patients undergoing percutaneous coronary intervention (PCI) were analyzed, comparing rapid inflation/deflation (n=376) with POP (n=416).
• Exclusion criteria included acute myocardial infarction, in-stent restenosis, chronic total occlusion, left main, and saphenous vein graft lesions.
• The primary endpoint was target vessel failure (TVF), a composite of target vessel revascularization (TVR), myocardial infarction, and cardiac death.

Main Results:

• Stent implantation using POP was associated with significantly lower TVF (10.1% vs. 17.8%, P < 0.0001) at a median follow-up of 1317 days.
• The reduction in TVF was primarily driven by decreased TVR (7% vs. 10.6%, P=0.0016) and cardiac death (2.9% vs. 5.8%, P=0.017).
• POP was identified as the sole independent predictor of reduced TVF (HR 0.43; P < 0.0001) in Cox regression and remained significant in propensity analysis.

Conclusions:

• Stent deployment utilizing the Pressure Optimization Protocol (POP) resulted in significantly reduced target vessel failure compared to rapid inflation/deflation.
• The findings strongly recommend the POP method for improving long-term clinical outcomes in patients undergoing percutaneous coronary intervention.