Changing features of stent-supported primary angioplasty for acute myocardial infarction: impact of new flexible stents.
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.
Tomoda
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H
Department of Cardiology, Tokai University Hospital, and Yamato Seiwa Hospital, Kanagawa, Japan.
Aoki
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N
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