title: Primary angioplasty: Effect of deferred stenting on stent size.
abstract: BACKGROUND
  Primary angioplasty with immediate stenting (IS) is the gold standard for ST-segment elevation myocardial infarction (STEMI). Deferred stenting (DS) has been proposed to limit periprocedural complications, and may influence stent size because of thrombus and spasm alleviation.
  
  
  OBJECTIVE
  We sought to study the effect of DS on stent size.
  
  
  METHODS
  Over the study period, 258 patients underwent primary angioplasty for STEMI (DS, n=84; IS, n=174). An informative coronary angiogram run - i.e. allowing for proper lesion analysis - was selected and anonymized by an independent operator. Two experienced operators randomly analysed these runs, and proposed stent dimensions after having measured vessel diameter and lesion length by quantitative coronary analysis. The primary objective was the variation in stent size between the two coronary angiograms.
  
  
  RESULTS
  The median delay between the two coronary angiograms was 2 days. Overall, the stent length was shorter (-1.64mm; P=0.030) and its diameter was larger (+0.13mm; P<0.001) during the second coronary angiogram, especially in the right coronary arteries.
  
  
  CONCLUSIONS
  DS led to the implantation of a larger and shorter stent; this is probably because DS allows for more accurate assessment of the residual lesion after relief of spasm and thrombus, and may have clinical consequences in terms of stent thrombosis and restenosis.
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude-Bernard Lyon 1, Hospices Civils de Lyon, 69100 Lyon, France.
authors.forename: Brahim
authors.initials: B
authors.lastname: Harbaoui
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Emsellem
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cassar
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Besnard
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Dauphin
authors.affiliation: Université d'Auvergne, Cardio-Vascular Interventional Therapy and Imaging, Image Science for Interventional Techniques, UMR 6284, 63000 Clermont-Ferrand, France; University Hospital of Clermont-Ferrand, Cardiology Department, 63000 Clermont-Ferrand, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude-Bernard Lyon 1, Hospices Civils de Lyon, 69100 Lyon, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Courand
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude-Bernard Lyon 1, Hospices Civils de Lyon, 69100 Lyon, France. Electronic address: pierre.lantelme@chu-lyon.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lantelme
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D015607:Stents; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Angioplastie primaire; Infarctus du myocarde; Myocardial infarction; Primary angioplasty; ST-segment elevation myocardial infarction; Stent; Syndrome coronarien aigu avec sus-décalage du segment ST; Thrombus