title: Direct stenting for stable angina pectoris is associated with reduced periprocedural microcirculatory injury compared with stenting after pre-dilation.
abstract: OBJECTIVE
  We conducted a randomized study to compare the effect of direct stenting (DS) and conventional stenting (CS) on post-procedural index of microcirculatory resistance (IMR) values.
  
  
  BACKGROUND
  Direct stenting has been suggested to reduce periprocedural microcirculatory injury compared with stenting that follows pre-dilation (CS). The index of microcirculatory resistance is a sensitive invasive marker of coronary microvascular resistance.
  
  
  METHODS
  Fifty patients admitted for elective percutaneous coronary intervention (PCI) were included. All patients had stable angina (Canadian Cardiovascular Society class <IV) related to a lesion suitable for DS and were randomized to DS (n = 25) or CS (n = 25). Baseline demographics and clinical and procedural data were comparable in both groups. An intracoronary pressure/temperature sensor-tipped guide wire was used. Thermodilution curves were obtained at baseline and during maximal hyperemia achieved by infusion of intravenous adenosine. The index of microcirculatory resistance was calculated from the ratio of the mean distal coronary pressure at maximal hyperemia to the inverse of mean hyperemic transit time.
  
  
  RESULTS
  After otherwise-uneventful PCI, patients treated with CS had significantly greater IMR (DS 13 +/- 3, CS 24 +/- 14; p < 0.01) and tended to have greater post-PCI troponin T values (DS 0.035 +/- 0.04, CS 0.17 +/- 0.02; p = 0.07). In the whole sample, 20% of patients had post-PCI troponin release (troponin T >0.03 ng/ml). Patients with troponin elevation had significantly greater post-PCI IMR values than patients without troponin elevation: 24.7 +/- 13.2 versus 16.9 +/- 10.2; p = 0.04.
  
  
  CONCLUSIONS
  In patients undergoing successful coronary stenting for stable angina, DS is associated with reduced microvascular dysfunction induced by PCI as compared with CS.
authors.affiliation: Cardiovascular Center, OLV Hospital, Aalst, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cuisset
authors.forename: Michalis
authors.initials: M
authors.lastname: Hamilos
authors.forename: Narbeh
authors.initials: N
authors.lastname: Melikian
authors.forename: Eric
authors.initials: E
authors.lastname: Wyffels
authors.forename: Jaydeep
authors.initials: J
authors.lastname: Sarma
authors.forename: Giovanna
authors.initials: G
authors.lastname: Sarno
authors.forename: Emanuele
authors.initials: E
authors.lastname: Barbato
authors.forename: Jozef
authors.initials: J
authors.lastname: Bartunek
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
mesh_terms: D000241:Adenosine / Q000494:pharmacology; D000368:Aged; D000787:Angina Pectoris / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D006328:Cardiac Catheterization; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000187:drug effects; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D008833:Microcirculation / Q000293:injuries; D008875:Middle Aged; D015607:Stents; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine