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Coronary stenting in patients undergoing percutaneous transluminal coronary angioplasty during acute myocardial
A E Rodriguez1, M Fernandez, O Santaera
1Cardiac Unit, Anchorena and Otamendi Hospitals, Buenos Aires, Argentina.
Insights
Coronary stenting effectively treats complications during percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI). This study shows stenting is safe and successful in managing suboptimal results and emergent issues in AMI patients.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Acute Myocardial Infarction Treatment
Background:
- Coronary stenting is established for PTCA complications but controversial in AMI due to thrombus.
- Suboptimal results and complications like abrupt closure or dissection occur during PTCA.
Purpose of the Study:
- To evaluate the safety and efficacy of intracoronary stenting in patients undergoing PTCA during AMI.
- To assess stenting for treating suboptimal results and complications in the acute phase of myocardial infarction.
Main Methods:
- Retrospective analysis of 30 patients (35 lesions) undergoing PTCA during AMI.
- Stents were deployed for suboptimal results (19), early loss (9), abrupt closure (2), and dissection (5).
- In-hospital and 11.8-month follow-up outcomes were analyzed.
Main Results:
- Successful stent deployment in all 35 lesions.
- Low in-hospital complication rate: 1 death (3%), 1 abrupt closure treated with PTCA, 10% vascular complications.
- Excellent long-term outcomes: no deaths or myocardial infarction at follow-up, freedom from angina in most patients.
Conclusions:
- Intracoronary stenting is a safe and effective strategy for managing suboptimal results and complications during PTCA in patients with AMI.
- Stenting offers favorable outcomes in this high-risk patient population, addressing concerns about intracoronary thrombus.
Abstract:
Although coronary stenting has been useful in the treatment of patients with suboptimal results, abrupt closure, and threatening occlusion after percutaneous transluminal coronary angioplasty (PTCA), its use in patients with acute myocardial infarction (AMI) is controversial because of the presence of intracoronary thrombus. In this study intracoronary stenting was used to treat suboptimal results and complications in 30 patients (35 lesions) undergoing PTCA during AMI. There were 28 men and 2 women, mean age 58 +/- 12 years. Thirteen patients (43%) had undergone rescue PTCA because of unsuccessful thrombolysis. Four patients had Killip's grade IV, 5 Killip's grade III, and 21 Killip's grade < or = 2 heart failure. Stents were placed in the 35 lesions because of suboptimal result (n = 19), early loss (n = 9), abrupt closure (n = 2), and coronary dissection with threatening occlusion (n = 5). All stents were deployed successfully. In-hospital complications included 1 in-hospital death (3.0%); no patient required emergency coronary artery bypass graft surgery. One patient (3.0%) developed abrupt closure and was successfully treated with PTCA and intracoronary thrombolysis. Vascular complications requiring blood transfusion developed in 3 of 30 patients (10%). At 11.8 months (range 4 to 24) follow-up, there were no deaths or myocardial infarction. One patient underwent coronary artery bypass grafting. The remaining patients were free of angina at follow-up. Thus, intracoronary stents can be used successfully to treat both suboptimal results and complications occurring in patients undergoing PTCA during AMI.