title: Clinical impact of undersized- versus oversized-stenting approaches in ST-elevation myocardial infarction.
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PCI) is the standard treatment in patients with ST-elevation myocardial infarction (STEMI). However, some patients still develop ST re-elevation during PCI, resulting in further myocardial damage and a poor outcome. An undersized-stenting approach may prevent ST re-elevation. We aimed to determine the association between final stent area and ST re-elevation during primary PCI for STEMI.
  
  
  METHODS
  Overall, 102 consecutive STEMI patients who underwent primary PCI under integrated backscatter intravascular ultrasound guidance were enrolled. The stent-reference (SR) ratio was defined as the stent cross-sectional area (CSA) divided by the average CSA of the 5-mm proximal and distal reference lumens. The patients were divided into two groups according to the SR ratio: undersize group (SR<1.0, n=62) and oversize group (SR≥1.0, n=40). The incidences of ST re-elevation and total ST resolution (STR) were compared.
  
  
  RESULTS
  The oversize group showed a higher incidence of ST re-elevation (32.5 vs. 9.7%, p=0.004) and a lower total STR (22.4±62.7 vs. 43.4±38.6%, p=0.04). After adjustment, the oversized-stenting approach was independently associated with ST re-elevation [odds ratio: 3.74, 95% confidence interval (CI) 1.27-12.1, p=0.02]. The peak creatine kinase-MB level was higher in the oversize group (341±259 vs. 242±208IU/l, p=0.04). The incidences of stent thrombosis and restenosis were similar between the two groups.
  
  
  CONCLUSIONS
  An oversized-stenting approach in patients with STEMI was associated with a higher incidence of ST re-elevation and a lower total STR, resulting in increased myocardial damage.
authors.affiliation: Division of Cardiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba district, Yokohama city, Kanagawa prefecture, Japan, 227-8501.
authors.forename: Sakura
authors.initials: S
authors.lastname: Nagumo
authors.affiliation: Division of Cardiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba district, Yokohama city, Kanagawa prefecture, Japan, 227-8501. Electronic address: kwaka@live.jp.
authors.forename: Kohei
authors.initials: K
authors.lastname: Wakabayashi
authors.affiliation: Division of Cardiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba district, Yokohama city, Kanagawa prefecture, Japan, 227-8501.
authors.forename: Miki
authors.initials: M
authors.lastname: Tsujiuchi
authors.affiliation: Division of Cardiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba district, Yokohama city, Kanagawa prefecture, Japan, 227-8501.
authors.forename: Chisato
authors.initials: C
authors.lastname: Sato
authors.affiliation: Department of Hygiene and Preventive Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa district, Tokyo, Japan, 142-8666.
authors.forename: Takenori
authors.initials: T
authors.lastname: Yamauchi
authors.affiliation: Department of Hygiene and Preventive Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa district, Tokyo, Japan, 142-8666.
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakadate
authors.affiliation: Division of Cardiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba district, Yokohama city, Kanagawa prefecture, Japan, 227-8501.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology; D003328:Coronary Thrombosis / Q000209:etiology; D052279:Creatine Kinase, MB Form / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011446:Prospective Studies; D011474:Prosthesis Design; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form
keywords: Intravascular ultrasound; Primary percutaneous coronary intervention; ST-elevation myocardial infarction; Undersized-stenting approach