Direct stenting is an independent predictor of improved survival in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction.
OBJECTIVE
Randomised trials have shown that direct stenting (DS) is associated with improved markers of reperfusion during primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI). However, data evaluating its impact on long-term clinical outcomes are lacking. We set out to evaluate the effect of DS on mortality in a contemporary population of patients undergoing PPCI for STEMI.


METHODS
Consecutive patients undergoing PPCI for STEMI at two high-volume UK heart attack centres between September 2008- December 2010 (n=1562) were included in the analysis. Local databases were analysed for patient demographics, as well as details on PPCI strategy, including use of DS versus predilatation (PD) followed by stenting, manual thrombus aspiration (MT) and glycoprotein IIb/IIIa inhibitors (GPIs). National databases were interrogated for in-hospital, 30-day and one-year mortality. To determine the impact of PPCI strategy on one-year survival, multivariate logistic analysis was performed.


RESULTS
Altogether 489 patients underwent DS (31.3%) and 1073 (68.7%) received PD prior to stenting. Patients receiving DS had reduced mortality at 30 days (2.04 versus 4.66%, p=0.01) and one year (3.27 versus 8.48%, p=0.0001). After multivariate adjustment, PD remained an independent predictor of one-year mortality (odds ratio 2.42, 95% confidence interval 1.08-5.45, p=0.032) along with age, cardiogenic shock, number of diseased vessels, and left main or proximal left anterior descending artery intervention. However, neither GPI use nor MT improved survival in either univariate or multivariate analyses.


CONCLUSIONS
In a contemporary, unselected population of patients undergoing PPCI for STEMI, DS - when compared with stenting after PD - is independently predictive of improved 30-day and one-year survival.
Department of Cardiology, Papworth Hospital, UK.
Liam M
LM
McCormick
Department of Cardiology, Papworth Hospital, UK.
Adam J
AJ
Brown
Department of Cardiology, Papworth Hospital, UK.
Liam S
LS
Ring
Department of Cardiology, Papworth Hospital, UK.
Parag R
PR
Gajendragadkar
Department of Cardiology, Norfolk and Norwich University Hospital, UK.
Seth J
SJ
Dockrill
Department of Cardiology, Norfolk and Norwich University Hospital, UK.
Simon P
SP
Hansom
Department of Cardiology, Papworth Hospital, UK.
Joel P
JP
Giblett
Department of Cardiology, Norfolk and Norwich University Hospital, UK.
Timothy J
TJ
Gilbert
Department of Cardiology, Papworth Hospital, UK.
Stephen P
SP
Hoole
Department of Cardiology, Papworth Hospital, UK nick.west@papworth.nhs.uk.
Nick E J
NE
West
D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome
Primary percutaneous coronary intervention; ST elevation myocardial infarction; direct stenting; mortality; predilatation