Angioplastie primaire à long terme : quel bénéfice des endoprothèses ?

Abstract

Background. – Primary stenting leads to a better short-term outcome than balloon angioplasty for acute myocardial infarction in randomised trials. However few data are available about the long-term outcome of primary stenting in acute myocardial infarction (AMI). Objectives. – The aim of this study was to compare the three-year outcome after primary stenting versus balloon angioplasty in patients with acute myocardial infarction. Methods. – We conducted a retrospective study including 157 patients with AMI in a single center. Patients underwent balloon angioplasty ( N =48) or primary stenting ( N =109) within six hours after the onset of chest pain. We looked at the outcome during three years focusing on global mortality, major adverse cardiac events (MACE), reinterventions and target vessel revascularization (TVR). Results. – The two groups are similar for their baseline characteristics. No difference was noted for in-patient mortality in the balloon angioplasty group and the primary stenting group (2.1 vs 2.8%; P =ns). The three-year mortality was not significantly different in the two groups. Regarding MACE (27.8 vs 31.7; P =0.95), reinterventions (20.4 vs 24.7 %; P =0.98) and TVR (18.6 vs 17.8%; P =0,69), both groups were statistically not different. Conclusion. – In the long-term patients treated with stent placement have similar rates of MACE, reinterventions or TVR than patients undergoing balloon angioplasty. If few studies noted a benefit in short-term outcomes, primary stenting doesn't improve the prognosis of acute myocardial infarction on long-term follow-up, which is dependent on atherosclerosis.