title: Changing features of stent-supported primary angioplasty for acute myocardial infarction: impact of new flexible stents.
abstract: Although primary coronary stenting for acute myocardial infarction (AMI) has been reported to be superior to primary percutaneous transluminal coronary angioplasty (PTCA), cautious entry criteria resulted in low-risk populations in these studies. This study was undertaken to delineate factors that have not been clarified by randomized multicenter studies and is based on the results of stent-supported primary PTCA for AMI using second-generation new stents. In 1994-1998, 355 AMI patients were studied < 12 hours after onset. The patients were divided into two groups: group 1 (n = 175) was treated in 1994-1996 and group 2 (n = 180) in 1997-1998. In group 1, bailout stenting was performed in 17% of the patients for acute coronary dissection or occlusion with use of Palmaz-Schatz stents. In group 2, stenting was performed in 62% of the patients for suboptimal coronary dilatation and dissection or occlusion, using second-generation flexible stents with excellent radial force in 65% of them (Multilink, GFX, and NIR). In-hospital death and reinfarction occurred in 7.4% of group 1 and 5.0% of group 2 patients, and follow-up death and reinfarction in 4.0% of group 1 and 0.6% of group 2 patients (p < 0.05). In-hospital target vessel revascularization was performed in 8.6% of group 1 and 3.3% of group 2 patients (p < 0.05), and follow-up target vessel revascularization in 21.1% of group 1 and 11.7% of group 2 patients (p<0.02). Thus, the total adverse clinical event rates were 36.0% in group 1 and 18.3% in group 2 (p < 0.01). In conclusion, outcomes of stent-supported coronary intervention in nonselected AMI patients have improved along with the availability of second-generation flexible stents, approaching the outcomes of primary stent studies in highly selected patients.
authors.affiliation: Department of Cardiology, Tokai University Hospital, and Yamato Seiwa Hospital, Kanagawa, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tomoda
authors.forename: N
authors.initials: N
authors.lastname: Aoki
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D018583:Pliability; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome