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Updated: May 13, 2026
Monitoring the Wall Mechanics During Stent Deployment in a Vessel
Published on: May 8, 2012
Postdilatation after stent deployment during primary percutaneous coronary intervention: a systematic review and
Teuku Muhammad Haykal Putra1, Wishnu Aditya Widodo1, Bayushi Eka Putra2
1Jakarta Heart Center, Department of Cardiology and Vascular Medicine, Jakarta, 13140, Indonesia.
Insights
Postdilatation during primary percutaneous coronary intervention (PCI) increases the risk of no-reflow but reduces major adverse cardiovascular events (MACE), particularly target vessel revascularization (TVR), in long-term follow-up.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Postdilatation during primary percutaneous coronary intervention (PCI) is debated due to concerns about suboptimal coronary blood flow.
- Its impact on patient outcomes requires further investigation.
Purpose of the Study:
- To evaluate the association between postdilatation in primary PCI and angiographic outcomes.
- To assess the impact of postdilatation on long-term clinical outcomes, including major adverse cardiovascular events (MACE).
Main Methods:
- A systematic literature search was conducted across major databases.
- Included studies focused on ST-segment elevation myocardial infarction patients undergoing primary PCI.
- Primary outcome was no-reflow; secondary outcomes included MACE (all-cause death, myocardial infarction, TVR, stent thrombosis).
Main Results:
- Ten studies with 3280 patients were analyzed; 40.7% received postdilatation.
- Postdilatation was linked to a higher risk of no-reflow (OR=1.33, P=.001).
- A trend towards reduced MACE (OR=0.70, P=.03) was observed, driven by decreased TVR (OR=0.41, P=.003).
Conclusions:
- Postdilatation in primary PCI is associated with an increased risk of immediate no-reflow.
- However, it significantly reduces long-term MACE, especially TVR.
- Selective application of postdilatation is recommended, with further research needed to identify suitable patient candidates.
Background:
The utilization of postdilatation in primary percutaneous coronary intervention (PCI) is feared to induce suboptimal coronary blood flow and compromise the outcome of the patients. This meta-analysis sought to verify whether postdilatation during primary PCI is associated with worse angiographic or long-term clinical outcomes.
Methods:
Systematic literature searches were conducted on PubMed, The Cochrane Library, ClinicalTrials.gov, EBSCO, and Europe PMC on 10 March 2024. Eligible studies reporting the outcomes of postdilatation among ST-segment elevation myocardial infarction patients were included. The primary outcome was no-reflow condition during primary PCI based on angiographic finding. The secondary clinical outcome was major adverse cardiovascular events (MACEs) comprising all-cause death, myocardial infarction, target vessel revascularization (TVR), and stent thrombosis.
Results:
Ten studies were finally included in this meta-analysis encompassing 3280 patients, which was predominantly male (76.6%). Postdilatation was performed in 40.7% cases. Postdilatation was associated with increased risk of no-reflow during primary PCI [Odd Ratio (OR) = 1.33, 95% Confidence Interval (CI): 1.12-1.58; P = .001)]. Conversely, postdilatation had a tendency to reduce MACE (OR = 0.70, 95% CI: 0.51-0.97; P = .03) specifically in terms of TVR (OR = 0.41, 95% CI: 0.22-0.74; P = .003). No significant differences between both groups in relation to mortality (OR = 0.58, 95% CI: 0.32-1.05; P = .07) and myocardial infarction (OR = 1.5, 95% CI: 0.78-2.89; P = .22).
Conclusions:
Postdilatation after stent deployment during primary PCI appears to be associated with an increased risk of no-reflow phenomenon after the procedure. Nevertheless, postdilatation strategy has demonstrated a significant reduction in MACE over the course of long-term follow-up. Specifically, postdilatation significantly decreased the occurrence of TVR. Key messages: What is already known on this topic? Optimizing stent deployment by performing postdilatation during percutaneous coronary intervention (PCI) is essential for long-term clinical outcomes. However, its application during primary PCI is controversial due to the fact that it may provoke distal embolization and worsen coronary blood flow. What this study adds? In this systematic review and meta-analysis of 10 studies, we confirm that postdilatation during primary PCI is associated with worse coronary blood flow immediately following the procedure. On the contrary, this intervention proves advantageous in improving long-term clinical outcomes, particularly in reducing target vessel revascularization. How this study might affect research, practice, or policy? Given the mixed impact of postdilatation during primary PCI, this strategy should only be applied selectively. Future research should focus on identifying patients who may benefit from such strategy.
