Stent Versus Non-Stent in Treating Intermediate Stenosis Culprit Lesions in Acute ST-Segment Elevation Myocardial
Jing Dai1, Shuzheng Lyu1, Xiantao Song1
1Department of Cardiology, Capital Medical University Affiliated to Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases.
Insights
Stent implantation significantly reduced adverse cardiac events in acute ST-segment elevation myocardial infarction (STEMI) patients with single vessel disease. This treatment demonstrated better efficacy and safety compared to non-stent approaches for these specific patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Acute ST-segment elevation myocardial infarction (STEMI) remains a leading cause of cardiovascular mortality.
- Optimal treatment strategies for STEMI patients with single vessel disease and intermediate stenosis culprit lesions require further investigation.
- Percutaneous coronary intervention (PCI) is a primary treatment, but the role of stent versus non-stent strategies needs clarification.
Purpose of the Study:
- To compare the efficacy and safety of stent implantation versus non-stent treatment in acute STEMI patients with single vessel disease and intermediate stenosis culprit lesions.
- To evaluate the rates of major adverse cardiac and cerebrovascular events (MACCE) and other clinical outcomes between the two treatment groups.
- To assess the long-term impact of stent use on ischemia-related events and procedural complications.
Main Methods:
- Retrospective study of 475 acute STEMI patients (symptom onset < 12 hours) with single vessel disease and intermediate stenosis culprit lesions.
- Patients were divided into a stent group (n=308) and a non-stent group (n=167) based on treatment during primary coronary angiography.
- Follow-up data was collected to compare MACCE, myocardial infarction (MI), cardiac death, stroke, composite ischemia outcomes, repeat revascularization, readmission, and bleeding rates.
Main Results:
- The stent group exhibited a significantly lower MACCE rate (5.5% vs. 12.0%, P=0.01) and nonfatal MI rate (2.9% vs. 7.2%, P=0.03) compared to the non-stent group.
- The composite ischemia outcome of death/MI/stroke was significantly lower in the stent group (8.1% vs. 14.4%, P=0.02).
- Cardiac death, all-cause death, stroke, repeat revascularization, ischemia-driven readmission, and bleeding rates were similar between the groups.
Conclusions:
- Stent implantation demonstrates superior efficacy in reducing adverse ischemia events for acute STEMI patients with single vessel disease and intermediate stenosis culprit lesions.
- The safety profile, including cardiac death, stroke, and bleeding, appears comparable between stent and non-stent strategies in this patient cohort.
- Stent use is associated with improved clinical outcomes, particularly concerning ischemia-related events, in the studied STEMI population.
Abstract:
To investigate the efficacy and safety of stent versus non-stent in treating acute ST-segment elevation myocardial infarction (STEMI) patients with single vessel disease and intermediate stenosis culprit lesions.Between September 2009 and May 2015, 475 acute STEMI patients (time from symptom onset < 12 hours) with single vessel disease and intermediate stenosis culprit lesions were retrospectively studied at Beijing Anzhen Hospital. The patients were divided into a stent group (n = 308) and non-stent group (n = 167) based on whether they received stent implantation or not during primary coronary angiography.During follow-up, the stent group patients had a lower major adverse cardiac and cerebrovascular event (MACCE) rate than the non-stent group: 5.5% versus 12.0%; P = 0.01; hazard ratio (HR) 0.35 [95% confidence interval (CI): 0.180.69]). The nonfatal myocardial infarction (MI) rate was lower in the stent group (2.9% versus 7.2%, P = 0.03). The cardiac death rate (1.9% versus 3%, P = 0.45) and stroke (0.6% versus 1.8%, P = 0.35) rate were similar between the stent and non-stent groups. The two groups shared similar all cause death rates: 4.9% versus 5.4%, respectively, P = 0.81; HR: 1.23 [95%CI: 0.51-2.99]. The composite ischemia outcome of death/MI/stroke was lower in the stent group (8.1% versus 14.4%, P = 0.02). The stent and non-stent groups had similar repeat revascularization rates (10.1% versus 11.4%, P = 0.67); ischemia driven readmission (19.5% versus 15.0%, P = 0.27), and bleeding (1.3% versus 1.2%, P = 1) rates.Stent implantation has a better efficacy and safety in reducing adverse ischemia events in acute STEMI patients with single vessel disease and intermediate stenosis culprit lesions.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care