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Effect of direct stenting on microvascular dysfunction during percutaneous coronary intervention in acute myocardial

Byung Gyu Kim1, Sung Woo Cho2, Jongkwon Seo1

  • 1Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea.

The Journal of International Medical Research
|September 30, 2022
PubMed

Insights

Direct stenting (DS) without predilatation during primary percutaneous coronary intervention (PPCI) did not improve microvascular reperfusion in ST-elevation myocardial infarction patients. Further large trials are needed to confirm these findings on microvascular resistance.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Myocardial Infarction Research

Background:

  • Microvascular dysfunction is a key complication following ST-elevation myocardial infarction (STEMI).
  • The role of direct stenting (DS) versus conventional stenting (CS) with predilatation in mitigating microvascular dysfunction during primary percutaneous coronary intervention (PPCI) remains incompletely understood.

Purpose of the Study:

  • To evaluate the impact of DS without predilatation on microvascular reperfusion compared to CS with predilatation in patients undergoing PPCI for STEMI.
  • To assess the effect of DS on the index of microcirculatory resistance (IMR) and other reperfusion markers.

Main Methods:

  • A randomized study involving 72 patients undergoing PPCI for STEMI.
  • Patients were assigned to either DS or CS with predilatation groups.
  • The primary endpoint was the post-PPCI index of microcirculatory resistance (IMR), with secondary endpoints including thrombolysis in myocardial infarction myocardial perfusion (TMP) grades, ST-segment resolution, and clinical outcomes.

Main Results:

  • No significant differences were observed in immediate microvascular reperfusion parameters (IMR, TMP grade, ST-segment resolution) between the DS and CS groups.
  • A higher proportion of patients in the CS group experienced no-reflow or cardiogenic shock, preventing IMR measurement, compared to the DS group.
  • Long-term left ventricular functional recovery and clinical outcomes were similar in both groups.

Conclusions:

  • Direct stenting without predilatation did not demonstrate a significant effect on the index of microcirculatory resistance in STEMI patients undergoing PPCI.
  • The study's findings warrant cautious interpretation due to a higher number of unmeasurable IMR cases in the conventional stenting group.
  • A larger, randomized clinical trial is necessary to definitively ascertain the benefits of direct stenting on microvascular reperfusion.
Abstract

Keywords:
MicrocirculationST-elevation myocardial infarctiondirect stentingindex of microcirculatory resistancepercutaneous coronary interventionpredilatation

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