title: A comparison of direct versus conventional stenting in patients undergoing primary angioplasty for ST-elevation myocardial infarction.
abstract: OBJECTIVE
  The aim of our study was to determine the impact of direct stenting (DS) on procedural success and the in-hospital outcome among patients with ST-elevation myocardial infarction (STEMI) treated with a primary percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  With improvements in stent designs, DS has become more widespread. The theoretical advantages of DS include a shorter procedural time, a lower contrast dose, and reduced spiral dissections, along with reduced radiation exposure and procedural costs.
  
  
  METHODS
  A total of 1992 consecutive STEMI patients were reviewed; 621 patients (31.2%) were included in the DS group and 1371 (68.8%) in the conventional stenting (CS) group. The clinical and angiographic characteristics, in-hospital outcomes, and predictors of unsuccessful primary angioplasty were analyzed.
  
  
  RESULTS
  The incidence of in-hospital major adverse cardiac events (MACE) was 6.1% in the CS group and 4.3% in the DS group. The difference between the two patient groups was not statistically significant for myocardial reinfarction (re-MI), target-vessel revascularization, and MACE. Nonetheless, the rates of in-hospital mortality and advanced heart failure were significantly lower in the DS group. CS [odds ratio (OR) 3.49, 95% confidence interval (CI) 1.65-7.37, P=0.001], Killip class 2/3 (OR 2.5, 95% CI 1.2-5.23, P=0.01), glomerular filtration rateless than 60 ml/min/1.73 m (OR 2.2, 95% CI 1.22-3.94, P=0.008), and anterior MI (OR 1.61, 95% CI 1.01-2.56, P=0.04) were found to be independent predictors of unsuccessful procedures.
  
  
  CONCLUSIONS
  DS improves the in-hospital outcomes of STEMI patients treated with primary PCI, particularly by reducing the rates of in-hospital mortality and advanced heart failure. CS was an independent predictor of unsuccessful PCI.
authors.affiliation: Department of Cardiology, School of Medicine, Balikesir University, Balikesir, Turkey. isikturgay@yahoo.com
authors.forename: Turgay
authors.initials: T
authors.lastname: Isik
authors.forename: Erkan
authors.initials: E
authors.lastname: Ayhan
authors.forename: Huseyin
authors.initials: H
authors.lastname: Uyarel
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ergelen
authors.forename: Gokhan
authors.initials: G
authors.lastname: Cicek
authors.forename: Damirbek
authors.initials: D
authors.lastname: Osmonov
authors.forename: Ceyhan
authors.initials: C
authors.lastname: Turkkan
authors.forename: Ayca
authors.initials: A
authors.lastname: Turer
authors.forename: Bahman
authors.initials: B
authors.lastname: Ghannadian
authors.forename: Mehmet
authors.initials: M
authors.lastname: Eren
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D005260:Female; D006333:Heart Failure / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey