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[Intracoronary stent in primary angioplasty in acute myocardial infarction]
F Pomar Domingo1, E Pérez Fernández, A Quesada Dorador
1Servicio de Cardiología, Hospital General Universitario de Valencia.
Insights
Coronary stenting during primary angioplasty for acute myocardial infarction (AMI) shows promising early results. This intervention restored vessel patency with a low complication rate, though long-term benefits require further study.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Medicine
Background:
- Stent implantation was historically contraindicated in primary percutaneous transluminal balloon angioplasty (PTCA) for acute myocardial infarction (AMI) due to thrombogenicity concerns.
- Early studies focused on the safety and efficacy of coronary stenting in this high-risk patient population.
Purpose of the Study:
- To evaluate the early outcomes of patients undergoing coronary stenting during primary PTCA for AMI.
- To assess the safety and efficacy of intracoronary stents in the context of primary angioplasty.
Main Methods:
- A cohort of 31 patients with AMI underwent primary PTCA with stent implantation between January 1995 and April 1996.
- Patients received heparin and dual antiplatelet therapy (ticlopidine and aspirin). Indications for stenting included suboptimal results, dissection, or elective placement.
- Demographic and clinical data, including infarct location and Killip class, were recorded.
Main Results:
- Coronary stenting successfully restored vessel patency in 94% of patients, achieving TIMI 3 flow.
- Angiographic follow-up in 80% of patients showed no stent occlusion and sustained TIMI 3 flow.
- The in-hospital mortality rate was 9% (3 deaths), primarily due to cardiogenic shock. Recurrent angina occurred in 6% of patients.
Conclusions:
- Intracoronary stent implantation can be performed successfully during primary angioplasty for AMI.
- The procedure demonstrated a low incidence of early complications, suggesting feasibility in selected patients.
- Further long-term studies are necessary to establish the sustained benefits of this approach.
Introduction And Objectives:
Stent implantation has been generally contraindicated during primary percutaneous transluminal balloon angioplasty in AMI, because of its possible trombogenicity. Report the early outcome of patients undergoing coronary stenting during primary PTCA.
Methods:
From january 1995 to april 1996, 31 patients underwent stent implantation in primary. Mean age 62 +/- 11 years. Infarct location was anterior in 20 (65%), and inferior in 11 patients (35%). Four patients were in Killip class IV. Mean onset of chest pain was 129 +/- 29 minutes. Indications for stenting were suboptimal result (64%), dissection (29%) and elective (6%). All patients were treated with heparin during 72 hours and antiplatelet therapy with ticlopidine and aspirin.
Results:
Coronary stenting restored vessel patency with TIMI 3 flow in 29 patients (94%) and TIMI 2 flow in 2 patients. Angiographic control was performed in 80% of the patients: no stent occlusion was observed and all patients showed a TIMI 3 flow. There were 3 deaths (9%): 2 patients died due to cardiogenic shock and 1 to severe right ventricular dysfunction. 2 patients (6%) had recurrent angina, due to other artery. One patient with left main coronary disease underwent elective coronary artery bypass graft surgery.
Conclusions:
Intracoronary stent can be used successfully during primary angioplasty with a low incidence of complications. The long term benefits remains to be established.