title: A novel stent inflation protocol improves long-term outcomes compared with rapid inflation/deflation deployment method.
abstract: BACKGROUND
  High-pressure inflation for coronary stent deployment is universally performed. However, the duration of inflation is variable and does not take into account differences in lesion compliance. We developed a standardized "pressure optimization protocol" (POP) using inflation pressure stability rather than an arbitrary inflation time or angiographic balloon appearance for stent deployment. Whether this approach improves long-term outcomes is unknown.
  
  
  RESULTS
  792 patients who underwent PCI using either rapid inflation/deflation (n = 376) or POP (n = 416) between January 2009 and March 2014 were included. Exclusion criteria included PCI for acute myocardial infarction, in-stent restenosis, chronic total occlusion, left main, and saphenous vein graft lesions. Primary endpoint was target vessel failure [TVF = combined end point of target vessel revascularization (TVR), myocardial infarction, and cardiac death]. Outcomes were analyzed in the entire cohort and in a propensity analysis. Stent implantation using POP with a median follow-up of 1317 days was associated with lower TVF compared with rapid inflation/deflation (10.1 vs. 17.8%, P < 0.0001). This difference was driven by a decrease in TVR (7 vs. 10.6%, P = 0.0016) and cardiac death (2.9 vs. 5.8%, P = 0.017) while there was no difference in myocardial infarction (1 vs. 1.9%, P = 0.19). In the Cox regression model, deployment using POP was the only independent predictor of reduced TVF (HR 0.43; 0.29-0.64; P < 0.0001). In the propensity analysis (330 patients per group) TVF remained lower with POP vs. rapid inflation/deflation (10 vs. 18%, P < 0.0001).
  
  
  CONCLUSIONS
  Stent deployment using POP led to reduced TVF compared to rapid I/D. These results recommend this method to improve long-term outcomes. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Central Arkansas Veterans Health Care System, Little Rock, Arkansas.|University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Vallurupalli
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Kasula
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Shiv
authors.initials: S
authors.lastname: Kumar Agarwal
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Naga Venkata K
authors.initials: NVK
authors.lastname: Pothineni
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Amjad
authors.initials: A
authors.lastname: Abualsuod
authors.affiliation: Central Arkansas Veterans Health Care System, Little Rock, Arkansas.|University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Abdul
authors.initials: A
authors.lastname: Hakeem
authors.affiliation: Central Arkansas Veterans Health Care System, Little Rock, Arkansas.|University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Zubair
authors.initials: Z
authors.lastname: Ahmed
authors.affiliation: Central Arkansas Veterans Health Care System, Little Rock, Arkansas.|University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Barry F
authors.initials: BF
authors.lastname: Uretsky
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: percutaneous coronary intervention; prolonged stent inflation; stent expansion; target vessel failure