Comparative trial of stent-like balloon angioplasty versus coronary stenting for acute myocardial infarction.
Primary PTCA has been shown to be superior to any thrombolytic regimen and offers higher reperfusion rates and better coronary flow grades. Its limitations include recurrent ischemia (10%-15%), infarct-related artery reocclusion (5%-10%), angiographic restenosis (35%-50%), and need to perform repeat PTCA or CABG at 6-month follow-up (20%). Thus, the current role of coronary stenting for acute myocardial infarction (AMI) is very promising. From December 1995 through January 1997, 335 patients underwent primary angioplasty during the first 12 hr from symptom onset at our institution. We performed a retrospective study comparing the in-hospital and 6-month follow-up outcome of 61 patients who underwent coronary stenting (stent group) against 61 patients with optimal (residual lesion stenosis < 30%) balloon-only primary angioplasty (stent-like group). Patients were routinely treated with aspirin, and ticlopidine was given only to the stent group. In-hospital major adverse cardiac events (MACE) rate was 11.5% without statistical differences between the groups. Cardiac death rate was similar in both groups (4.9 vs. 6.6%; P = 1.0) and only two (3.3%) patients from the stent group and none from the PTCA group had nonfatal myocardial reinfarction. At 6-month follow-up, the rate of recurrent angina was higher in the stent-like group (30.9 vs. 7.1%; P < 0.001). Multivariate analysis showed that only stenting of the infarct-related artery was a borderline independent predictor for MACE (OR = 0; 95% CI = 0-1; P = 0.057). Primary stenting for AMI reduces the rate of recurrent angina or symptoms and MACE at 6-month follow-up.
Eid-Lidt
G
G
Department of Interventional Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, México City, México. eidgue@cardiologia.org.mx
Villavicencio-Fernández
R
R
Ponce-De-León-Rosales
S
S
Gaspar
J
J
Luna-Guerra
J
J
Ban-Hayashi
E
E
Peña-Duque
M A
MA
Martinez-Rios
M A
MA
D000800:Angioplasty, Balloon; D016022:Case-Control Studies; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome