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Comparison of Direct Stenting With Conventional Stent Implantation in Acute Myocardial Infarction

Small studies have suggested that direct stenting without balloon predilatation in ST-segment elevation myocardial infarction may reduce microcirculatory dysfunction. To examine the clinical benefits of direct stenting in a large cohort of patients who underwent primary percutaneous coronary interve... Full description

Journal Title: The American journal of cardiology 2011, Vol.108 (12), p.1697-1703
Main Author: Möckel, Martin, MD
Other Authors: Vollert, Jörn, MD , Lansky, Alexandra J., MD , Witzenbichler, Bernhard, MD , Guagliumi, Giulio, MD , Peruga, Jan Z., MD , Brodie, Bruce R., MD , Kornowski, Ran, MD , Dudek, Dariusz, MD , Farkouh, Michael E., MD , Parise, Helen, ScD , Mehran, Roxana, MD , Stone, Gregg W., MD
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: New York, NY: Elsevier Inc
ID: ISSN: 0002-9149
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title: Comparison of Direct Stenting With Conventional Stent Implantation in Acute Myocardial Infarction
format: Article
creator:
  • Möckel, Martin, MD
  • Vollert, Jörn, MD
  • Lansky, Alexandra J., MD
  • Witzenbichler, Bernhard, MD
  • Guagliumi, Giulio, MD
  • Peruga, Jan Z., MD
  • Brodie, Bruce R., MD
  • Kornowski, Ran, MD
  • Dudek, Dariusz, MD
  • Farkouh, Michael E., MD
  • Parise, Helen, ScD
  • Mehran, Roxana, MD
  • Stone, Gregg W., MD
subjects:
  • Abridged Index Medicus
  • Aged
  • Biological and medical sciences
  • Cardiac patients
  • Cardiology
  • Cardiology. Vascular system
  • Cardiovascular
  • Clinical outcomes
  • Comparative analysis
  • Coronary artery bypass
  • Coronary heart disease
  • Diseases of the cardiovascular system
  • Female
  • Heart
  • Heart attack
  • Heart attacks
  • Humans
  • Male
  • Medical sciences
  • Middle Aged
  • Myocardial Infarction - surgery
  • Myocarditis. Cardiomyopathies
  • Prospective Studies
  • Prosthesis Implantation - methods
  • Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
  • Stent (Surgery)
  • Stents
  • Transluminal angioplasty
  • Transplants & implants
  • Universities and colleges
ispartof: The American journal of cardiology, 2011, Vol.108 (12), p.1697-1703
description: Small studies have suggested that direct stenting without balloon predilatation in ST-segment elevation myocardial infarction may reduce microcirculatory dysfunction. To examine the clinical benefits of direct stenting in a large cohort of patients who underwent primary percutaneous coronary intervention treated with contemporary pharmacotherapy, the 1-year outcomes from the multicenter, randomized Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial were analyzed. A total of 3,602 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were enrolled. The present study cohort consisted of 2,528 patients in whom single lesions (excluding bypass grafts) were treated with stent implantation. At operator discretion, direct stenting was attempted in 698 patients (27.6%), and stenting was performed after predilatation in 1,830 patients (72.4%). Propensity-score matching was performed to reduce bias. Direct stenting was successful in 677 patients (97.0%). ST-segment resolution at 60 minutes after the procedure was improved in patients who underwent direct compared to conventional stenting (median 74.8% vs 68.9%, respectively, p = 0.01). At 1-year follow-up, direct compared to conventional stenting was associated with a significantly lower rate of all-cause death (1.6% vs 3.8%, p = 0.01) and stroke (0.3% vs 1.1%, p = 0.049), with nonsignificant differences in target lesion revascularization, myocardial infarction, stent thrombosis, and major bleeding. Death at 1 year remained significantly lower in the direct stenting group after multivariate adjustment (hazard ratio 0.42, 95% confidence interval 0.21 to 0.86, p = 0.02) and in a propensity score–based analysis (hazard ratio 0.92, 95% confidence interval 0.88 to 0.95, p = 0.02). In conclusion, compared to stent implantation after predilatation, direct stenting is safe and effective in appropriately selected lesions in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention and may result in improved survival.
language: eng
source:
identifier: ISSN: 0002-9149
fulltext: no_fulltext
issn:
  • 0002-9149
  • 1879-1913
url: Link


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titleComparison of Direct Stenting With Conventional Stent Implantation in Acute Myocardial Infarction
creatorMöckel, Martin, MD ; Vollert, Jörn, MD ; Lansky, Alexandra J., MD ; Witzenbichler, Bernhard, MD ; Guagliumi, Giulio, MD ; Peruga, Jan Z., MD ; Brodie, Bruce R., MD ; Kornowski, Ran, MD ; Dudek, Dariusz, MD ; Farkouh, Michael E., MD ; Parise, Helen, ScD ; Mehran, Roxana, MD ; Stone, Gregg W., MD
creatorcontribMöckel, Martin, MD ; Vollert, Jörn, MD ; Lansky, Alexandra J., MD ; Witzenbichler, Bernhard, MD ; Guagliumi, Giulio, MD ; Peruga, Jan Z., MD ; Brodie, Bruce R., MD ; Kornowski, Ran, MD ; Dudek, Dariusz, MD ; Farkouh, Michael E., MD ; Parise, Helen, ScD ; Mehran, Roxana, MD ; Stone, Gregg W., MD ; Horizons-AMI Trial Investigators
descriptionSmall studies have suggested that direct stenting without balloon predilatation in ST-segment elevation myocardial infarction may reduce microcirculatory dysfunction. To examine the clinical benefits of direct stenting in a large cohort of patients who underwent primary percutaneous coronary intervention treated with contemporary pharmacotherapy, the 1-year outcomes from the multicenter, randomized Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial were analyzed. A total of 3,602 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were enrolled. The present study cohort consisted of 2,528 patients in whom single lesions (excluding bypass grafts) were treated with stent implantation. At operator discretion, direct stenting was attempted in 698 patients (27.6%), and stenting was performed after predilatation in 1,830 patients (72.4%). Propensity-score matching was performed to reduce bias. Direct stenting was successful in 677 patients (97.0%). ST-segment resolution at 60 minutes after the procedure was improved in patients who underwent direct compared to conventional stenting (median 74.8% vs 68.9%, respectively, p = 0.01). At 1-year follow-up, direct compared to conventional stenting was associated with a significantly lower rate of all-cause death (1.6% vs 3.8%, p = 0.01) and stroke (0.3% vs 1.1%, p = 0.049), with nonsignificant differences in target lesion revascularization, myocardial infarction, stent thrombosis, and major bleeding. Death at 1 year remained significantly lower in the direct stenting group after multivariate adjustment (hazard ratio 0.42, 95% confidence interval 0.21 to 0.86, p = 0.02) and in a propensity score–based analysis (hazard ratio 0.92, 95% confidence interval 0.88 to 0.95, p = 0.02). In conclusion, compared to stent implantation after predilatation, direct stenting is safe and effective in appropriately selected lesions in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention and may result in improved survival.
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languageeng
publisherNew York, NY: Elsevier Inc
subjectAbridged Index Medicus ; Aged ; Biological and medical sciences ; Cardiac patients ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Clinical outcomes ; Comparative analysis ; Coronary artery bypass ; Coronary heart disease ; Diseases of the cardiovascular system ; Female ; Heart ; Heart attack ; Heart attacks ; Humans ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - surgery ; Myocarditis. Cardiomyopathies ; Prospective Studies ; Prosthesis Implantation - methods ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Stent (Surgery) ; Stents ; Transluminal angioplasty ; Transplants & implants ; Universities and colleges
ispartofThe American journal of cardiology, 2011, Vol.108 (12), p.1697-1703
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5Peruga, Jan Z., MD
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9Farkouh, Michael E., MD
10Parise, Helen, ScD
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12Stone, Gregg W., MD
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0Comparison of Direct Stenting With Conventional Stent Implantation in Acute Myocardial Infarction
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descriptionSmall studies have suggested that direct stenting without balloon predilatation in ST-segment elevation myocardial infarction may reduce microcirculatory dysfunction. To examine the clinical benefits of direct stenting in a large cohort of patients who underwent primary percutaneous coronary intervention treated with contemporary pharmacotherapy, the 1-year outcomes from the multicenter, randomized Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial were analyzed. A total of 3,602 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were enrolled. The present study cohort consisted of 2,528 patients in whom single lesions (excluding bypass grafts) were treated with stent implantation. At operator discretion, direct stenting was attempted in 698 patients (27.6%), and stenting was performed after predilatation in 1,830 patients (72.4%). Propensity-score matching was performed to reduce bias. Direct stenting was successful in 677 patients (97.0%). ST-segment resolution at 60 minutes after the procedure was improved in patients who underwent direct compared to conventional stenting (median 74.8% vs 68.9%, respectively, p = 0.01). At 1-year follow-up, direct compared to conventional stenting was associated with a significantly lower rate of all-cause death (1.6% vs 3.8%, p = 0.01) and stroke (0.3% vs 1.1%, p = 0.049), with nonsignificant differences in target lesion revascularization, myocardial infarction, stent thrombosis, and major bleeding. Death at 1 year remained significantly lower in the direct stenting group after multivariate adjustment (hazard ratio 0.42, 95% confidence interval 0.21 to 0.86, p = 0.02) and in a propensity score–based analysis (hazard ratio 0.92, 95% confidence interval 0.88 to 0.95, p = 0.02). In conclusion, compared to stent implantation after predilatation, direct stenting is safe and effective in appropriately selected lesions in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention and may result in improved survival.
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21Myocarditis. Cardiomyopathies
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titleComparison of Direct Stenting With Conventional Stent Implantation in Acute Myocardial Infarction
authorMöckel, Martin, MD ; Vollert, Jörn, MD ; Lansky, Alexandra J., MD ; Witzenbichler, Bernhard, MD ; Guagliumi, Giulio, MD ; Peruga, Jan Z., MD ; Brodie, Bruce R., MD ; Kornowski, Ran, MD ; Dudek, Dariusz, MD ; Farkouh, Michael E., MD ; Parise, Helen, ScD ; Mehran, Roxana, MD ; Stone, Gregg W., MD
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abstractSmall studies have suggested that direct stenting without balloon predilatation in ST-segment elevation myocardial infarction may reduce microcirculatory dysfunction. To examine the clinical benefits of direct stenting in a large cohort of patients who underwent primary percutaneous coronary intervention treated with contemporary pharmacotherapy, the 1-year outcomes from the multicenter, randomized Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial were analyzed. A total of 3,602 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were enrolled. The present study cohort consisted of 2,528 patients in whom single lesions (excluding bypass grafts) were treated with stent implantation. At operator discretion, direct stenting was attempted in 698 patients (27.6%), and stenting was performed after predilatation in 1,830 patients (72.4%). Propensity-score matching was performed to reduce bias. Direct stenting was successful in 677 patients (97.0%). ST-segment resolution at 60 minutes after the procedure was improved in patients who underwent direct compared to conventional stenting (median 74.8% vs 68.9%, respectively, p = 0.01). At 1-year follow-up, direct compared to conventional stenting was associated with a significantly lower rate of all-cause death (1.6% vs 3.8%, p = 0.01) and stroke (0.3% vs 1.1%, p = 0.049), with nonsignificant differences in target lesion revascularization, myocardial infarction, stent thrombosis, and major bleeding. Death at 1 year remained significantly lower in the direct stenting group after multivariate adjustment (hazard ratio 0.42, 95% confidence interval 0.21 to 0.86, p = 0.02) and in a propensity score–based analysis (hazard ratio 0.92, 95% confidence interval 0.88 to 0.95, p = 0.02). In conclusion, compared to stent implantation after predilatation, direct stenting is safe and effective in appropriately selected lesions in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention and may result in improved survival.
copNew York, NY
pubElsevier Inc
pmid21906709
doi10.1016/j.amjcard.2011.07.040