In‐Hospital Results of the Wiktor Stent in Acute Myocardial Infarction

Abstract

Background: Coronary angioplasty has been established as the preferred method of treatment for patients with acute myocardial infarction when they are admitted to a hospital with skilled interventional cardiologists and personnel well‐trained in cardiac catheterization techniques. Nevertheless, the possibilities of artery reocclusion, recurrent ischemia, and high rates of late restenosis have made some investigators believe that coronary stenting could be a better mechanical reperfusion technique than conventional balloon angioplasty. Methods: We reviewed the in‐hospital results of patients who received a Wiktor coronary stent implant during primary or rescue angioplasty for acute myocardial infarction within 6 hours of either the onset of pain or the recurrence of symptoms after thrombolytic administration. We excluded patients in shock and those whose symptoms were produced by an acute occlusion after an angioplasty procedure. Quantitative coronary analysis of the lesions treated were performed by automatic border detection using the on‐line DCI system by Phillips or off‐line CMS system by Medis. Results: Thirty‐three patients, aged 59 ± 13 years (79% male), received one or more coronary stents (41 stents were implanted) for treatment of acute myocardial infarction during primary angioplasty (30) or rescue angioplasty (3) after the onset of symptoms. Twenty‐nine of the patients were in Killip Class I (patients in shock were excluded). The infarct related artery was the left anterior descending in 19 patients (58%), the right coronary artery in 12 (36%), and the left circumflex in 2 (6%). Twenty‐seven patients (82%) had TIMI 0‐1 flow on the initial angiography. After stent implantation 100% of the patients had TIMI III (85%) or TIMI II (15%) flow. The minimal luminal diameter of the infarct related artery increased from 0.22 ± 0.38 mm before the procedure to 2.99 ± 0.48 mm after stem implantation. Most of the patients (27 [84%]) received antiaggregation therapy‐after the procedure. There was no mortality or reinfarction, although one patient had an embolic stroke. There were no cases of acute or subacute thrombosis of the stent. Conclusion: Use of the Wiktor stent during angioplasty for acute myocardial infarction is followed by immediate angiographic and in‐hospital clinical results comparable to results obtained with other types of stent. This stent is particularly useful in curved lesions and those with an important collateral branch arising from the lesion. If the angiographic result is optimal, the patient can be managed with antiaggregant therapy after stent implantation.