Outcomes of direct stenting in patients with ST-elevated myocardial infarction

Area of Science:

• Cardiology
• Interventional Cardiology
• Acute Coronary Syndromes

Background:

• ST-elevated myocardial infarction (STEMI) requires prompt treatment.
• Primary percutaneous coronary intervention (P-PCI) is a standard reperfusion therapy for STEMI.
• Conventional stenting (CS) involves predilation before stent deployment, while direct stenting (DS) deploys the stent without predilation.

Purpose of the Study:

• To compare the procedural results and long-term mortality of DS versus CS in patients undergoing P-PCI for STEMI.
• To evaluate the impact of baseline thrombolysis in myocardial infarction (TIMI) flow grade on outcomes in the CS group.

Main Methods:

• Retrospective analysis of 2306 patients undergoing P-PCI within 12 hours of symptom onset.
• Patients were divided into DS (n=597) and CS (n=1709) groups.
• The CS group was further stratified by baseline TIMI flow grade (≥1 or 0).
• Prospective follow-up for clinical events, focusing on postprocedural myocardial reperfusion and all-cause mortality.

Main Results:

• DS group demonstrated superior final TIMI-3 flow, myocardial blush grade 3, and ST-segment resolution.
• DS was associated with better left ventricular ejection fraction and reduced distal embolization.
• In-hospital (1.5% vs 4.6%) and long-term all-cause mortality (8.8% vs 17.0%) were significantly lower in the DS group compared to the CS group.
• Kaplan-Meier analysis revealed similar survival for DS and CS with TIMI flow ≥1, but worse survival for CS with TIMI flow 0.

Conclusions:

• Direct stenting in P-PCI is linked to improved angiographic outcomes and enhanced long-term survival in STEMI patients.
• Despite better outcomes, DS demonstrated comparable in-hospital and long-term mortality to matched conventional stenting patients.
• Baseline TIMI flow grade is a critical determinant of outcomes in conventional stenting for STEMI.