Abstract
Among1297 patients with STEMI admitted to the coronary care unit and subjected to PCIs from 2006 to 2015 there were 330 women(25.4 %). Data from 161 women (48.8 %) who underwent DS were compared with those from 169 women who underwent indirectstenting (IS). Among patients of IS group in 148 (87.6 %) stenting was performed after predilation, in 7 (4.1 %) after manual thrombusaspiration, and in 14 (8.3 %) after combination of predilation and thrombus aspiration. The rate of angiographic success washigher in the DS group (97.5 vs. 87.6 %, р<0.001). Rates of deaths (4.3 vs. 11.8 %; p=0.013), major adverse cardiac events (MACE)(4.3 vs. 13 %; p=0.005), and no-reflow (1.9 % vs. 11.2 %; p=0.013) were significantly lower in the DS group. There were no differencesin rates of recurrent myocardial infarction and access site complications. Following propensity score matching, each group contained 78 patients. Rates of MACE (2.6 vs. 14.1 %; p=0.009) and deaths (2.6 vs. 12.8 %; p=0.016) remained significantly lower in the DS group. After multivariate adjustment, DS strategy was independently associated with lower mortality (odds ratio [OR] 0.29; 95 % confidence interval [CI] 0.09-0.97; p=0.04) and MACE (OR=0.28; 95 %CI 0.09-0.087; p=0.03). DS strategy in STEMI female patients turned out to be safe and effective technique.
Highlights
direct stenting (DS) strategy was independently associated with lower mortality and major adverse cardiac events (MACE) (OR=0.28; 95 %CI 0.09–0.087; p=0.03)
Direct Stenting Strategy is Associated with Improved Outcomes in Patients with Totally Occluded Culprit Arteries Undergoing Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction
Summary
Aim of this study was to evaluate the impact of direct stenting (DS) strategy on the results of treatment of female patients with STelevation myocardial infarction (STEMI) undergoing percutaneous coronary interventions (PCIs). Целью настоящей работы была оценка влияния стратегии прямого стентирования при проведении первичных ЧКВ на результаты лечения пациентов женского пола с ОИМпST. При оценке результатов вмешательств анализировали следующие показатели: смертность, частота рецидивов инфаркта миокарда (ИМ), тромбозов стентов, развития феномена no-reflow, который определяли как отсутствие адекватной перфузии миокарда после восстановления коронарного кровотока [11]. Для оценки взаимосвязи прямого стентирования и развития осложнений на госпитальном этапе применяли многофакторный анализ – метод бинарной логистической регрессии. Для достижения сопоставимости групп и исключения вероятности систематической ошибки при оценке влияния прямого стентирования на частоту развития осложнений на госпитальном этапе применяли метод случайного отбора подобного по вероятности (propensity score matching) [12]. Определялась тенденция к более частому использованию трансрадиального доступа и сокращению времени дверь–баллон у больных группы прямого стентирования
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