Outcomes of direct stenting in patients with ST-elevated myocardial infarction.

Abstract

We compared direct stenting (DS) with conventional stenting (CS) - i.e., stenting after predilation - during primary percutaneous coronary intervention (P-PCI) in terms of procedural results and long-term mortality in patients with ST-elevated myocardial infarction (STEMI). We retrospectively analyzed 2306 patients (mean age 59years, 22% female) who underwent P‑PCI within 12 h of symptom onset. Patients were then followed up prospectively for clinical events. Patients were divided into aDS group (n= 597) and aCS group (n= 1709). The CS group was further divided into aCS-1 group (baseline thrombolysis in myocardial infarction [TIMI] flow grade≥ 1) and aCS-2 group (baseline TIMI flow grade 0). Main outcome measures were postprocedural myocardial reperfusion and all-cause mortality in long-term follow-up. Patients in the DS group had ahigher percentage of final TIMI-3 flow, myocardial blush grade3 and complete ST-segment resolution, better left ventricular ejection fraction, and alower incidence of distal embolization compared with CS patients. In-hospital (1.5 vs. 4.6%, respectively, p= 0.001) and long-term all-cause mortality (8.8 vs. 17.0%, respectively, p< 0.001) were significantly lower in the DS group than in the CS group. Kaplan-Meier survival analysis showed similar survival rates in the DS and CS-1 groups (log-rank p= 0.40), but significantly worse survival in the CS-2 group than in the other groups (log-rank p< 0.001). After adjusting for risk factors, DS was not found to be apredictor of long-term mortality. DS in P‑PCI was associated with better postprocedural angiographic results and long-term survival. However, the DS group had similar in-hospital and long-term mortality to matched patients in the CS group.