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Late coronary artery stenting in patients with acute myocardial infarction
I C Hsieh1, H J Chang, M S Chern
1Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan, Republic of China.
Insights
Late coronary stenting after acute myocardial infarction is safe and effective. This therapy improves blood flow and benefits patients, showing positive outcomes in long-term follow-up.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- The safety and efficacy of late coronary artery stenting in the infarct-related artery following acute myocardial infarction have not been previously established.
- Acute myocardial infarction (AMI) remains a leading cause of mortality and morbidity worldwide.
Purpose of the Study:
- To evaluate the safety and efficacy of performing late coronary artery stenting of the infarct-related artery in patients who have experienced acute myocardial infarction.
- To assess the long-term outcomes and benefits of this late reperfusion strategy.
Main Methods:
- A cohort of 117 consecutive patients with acute myocardial infarction underwent stenting of the infarct-related artery without coumarin therapy, using a ticlopidine/aspirin regimen.
- A total of 136 Palmaz-Schatz stents were implanted in 130 lesions, a median of 9 days after the acute event.
- Follow-up included clinical assessment and coronary angiography in a subset of patients.
Main Results:
- Stenting significantly increased minimal luminal diameter (MLD) from 0.66 to 3.14 mm (P< .001).
- Acute complications were low, with one instance of thrombosis and one requiring emergency bypass surgery.
- During 14 months of follow-up, restenosis occurred in 13% of patients, and left ventricular ejection fraction improved from 47% to 55% (P< .001).
Conclusions:
- Late coronary stenting of the infarct-related artery is a safe and effective late reperfusion therapy for patients with acute myocardial infarction.
- This strategy demonstrates potential benefits for patient outcomes, including improved cardiac function.
Background:
The safety and efficacy of late coronary artery stenting of the infarct-related artery after acute infarction has not been evaluated previously.
Methods And Results:
Coronary artery stenting was performed in 117 consecutive patients with acute infarction who were receiving ticlopidine/aspirin regimen without coumarin. There were 97 men and 18 women, aged 58+/-11 (mean +/- SD) years. A total of 136 Palmaz-Schatz stents were successfully implanted in 130 lesions 15+/-8 days after acute myocardial infarction (median 9 days) in 115 of 117 (98%) patients. The minimal luminal diameter (MLD) increased from 0.66+/-0.46 to 3.14+/-0.53 mm (P< .001), with an acute gain of 2.49+/-0.61 mm. One patient had acute thrombosis requiring further stenting and another patient received emergency bypass surgery. There was no subacute thrombosis or other complications. During a follow-up duration of 14+/-3 months, 2 patients had angina pectoris develop and 1 died suddenly. Sixty-two patients underwent a follow-up coronary angiography 195+/-36 days after stenting. Restenosis was noted in 8 patients (13%); the MLD was 2.19+/-0.73 mm, the late loss was 0.96+/-0.65 mm (P< .001), the loss index was 0.39+/-0.28, and the net gain was 1.56+/-0.79 mm (P< .001). The angiographic left ventricular ejection fraction increased from 47%+/-12% to 55%+/-12% (P< .001).
Conclusions:
Late coronary stenting of the infarct-related artery in patients with acute myocardial infarction is a safe and effective late reperfusion therapy and may be beneficial to the patients.