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[Primary stent treatment in the acute phase of myocardial infaction]
A Medina1, M Pan, J Suárez de Lezo
1Hospital del Pino, Universidad de Las Palmas, Las Palmas de Gran Canaria.
Insights
Primary stenting in acute myocardial infarction shows promising initial and six-month outcomes. This interventional cardiology technique offers an alternative to thrombolytic therapy, improving outcomes for eligible patients.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Acute myocardial infarction (AMI) treatment faces challenges with reocclusion and restenosis after balloon angioplasty.
- Primary stenting is explored as a method to overcome limitations of traditional therapies for AMI.
Purpose of the Study:
- To evaluate the efficacy of primary Palmaz-Schatz stent implantation in patients with evolving myocardial infarction.
- To assess the initial and six-month outcomes of primary stenting without adjunctive thrombolysis.
Main Methods:
- A study of 59 AMI patients treated with elective Palmaz-Schatz stent implantation within 3.1 hours of symptom onset.
- Mechanical recanalization followed by stent implantation in suitable lesions; no thrombolytic therapy used.
- Two patients received treatment under percutaneous cardiopulmonary support due to cardiogenic shock.
Main Results:
- Successful stent implantation in 59 patients, with significant improvement in minimal lumen diameter post-procedure.
- One patient experienced early recurrence requiring additional stenting; others had favorable clinical courses.
- Six-month angiographic follow-up in 29 patients revealed a 21% restenosis rate (>50% stenosis).
Conclusions:
- Primary stent implantation in selected AMI patients yields favorable initial results.
- The procedure demonstrates good six-month outcomes, suggesting its viability as an alternative treatment.
- Further research may explore optimizing stent selection and technique to reduce restenosis rates.
Introduction:
Although direct balloon angioplasty has emerged as an alternative to thrombolytic therapy in patients with acute myocardial infarction, reocclusion and restenosis rates are limiting factors. We postulated that these limitations could be partly overcome by primary stenting of the responsible lesion.
Material And Methods:
Since January/94 we have studied 59 patients with acute myocardial infarction who were treated in the early phase (3.1 +/- 2 hours since the onset of symptoms) by elective Palmaz-Schatz stent implantation. No adjunctive thrombolytic therapy was associated. Two patients were in cardiogenic shock and were treated under percutaneous cardiopulmonary support. At cardiac catheterization a left ventriculography and coronary angiograms were obtained. Then, mechanical recanalization of the responsible lesion was performed. If the angiographic anatomy was considered suitable, a stent was implanted at the lesion.
Results:
The infarct related artery was the left anterior descending in 29 patients, the circumflex in 14 and the right coronary artery in 16. At baseline conditions, 40 patients had a totally occluded artery and 19 showed a TIMI-grande 1 antegrade flow. One patient had an early clinical recurrence 4 days later, which required an additional divided Palmaz-Schatz stent at the distal portion of the lesion, in order to seal a residual dissection. All remaining patients had a favourable clinical course without major complications. Immediately after treatment the minimal lumen diameter was 3.2 +/- 0.4 mm and no residual stenosis was detectable at the treated segment. Six-month angiographic reevaluation was performed in all 29 (49%) eligible patients. Restenosis (> 50% stenosis) was detected in 6 out of the 29 evaluated patients (21%).
Conclusions:
Primary stent implantation in selected patients with an evolving myocardial infarction provides good initial and 6-month results.