Direct Stenting Versus Stenting After Pre-dilation in Primary PCI for ST-Elevation Myocardial Infarction

Abstract

Background: Direct stenting and stenting after pre-dilation are strategies used in the setting of Primary PCI for ST-elevation Myocardial Infarction (STEMI). There is a paucity of evidence to guide one treatment strategy over the other. Methods: We performed a retrospective review of a registry of Primary PCI for STEMIs between April 2013 and November 2018. Procedures were performed at Wollongong Hospital, a large tertiary centre in NSW, Australia. We collected data on baseline characteristics, procedural characteristics, procedural complications, and follow up data on Major Adverse Cardiovascular Events (MACE). Results: Data were collected on a total of 310 patients who were treated with Primary PCI for STEMI. Of these, 260 (83.9%) were treated with stenting after pre-dilatation, 38 (12.3%) were treated with a direct stenting strategy (including 11 with aspiration thrombectomy, 28 without), and 12 (3.9%) of patients were treated with “Plain Old Balloon Angioplasty” (POBA). Mean follow up duration was 29 months. There was a complication rate of 7.9% in the direct stenting arm (including a 5.3% risk of slow flow or no-reflow). This was higher than the rate for stenting with pre-dilatation, with a 6.9% rate of procedural complication (including a 1.9% risk of slow flow/no-reflow), though this did not reach statistical significance (p = 0.83). Incidence of MACE on follow up was 15.8% for the direct stenting arm vs 17% for the stenting with pre-dilatation (p = 0.86). Conclusion: In our cohort, there was no statistically significant difference in incidence of peri-procedural complications and MACE between direct stenting and stenting after pre-dilation.