Primary PCI For ST-elevation Myocardial Infarction Research Articles

Ischemia-guided vs routine non-culprit vessel angioplasty for patients with ST segment elevation myocardial infarction and multi-vessel disease: the IAEA SPECT STEMI trial

BackgroundIn patients with multi-vessel disease presenting with ST elevation myocardial infarction (STEMI), the efficacy and safety of ischemia-guided, vs routine non-culprit vessel angioplasty has not been adequately studied. MethodsWe conducted an international, randomized, non-inferiority trial comparing ischemia-guided non-culprit vessel angioplasty to routine non-culprit vessel angioplasty, following primary PCI for STEMI. The primary outcome was the between-group difference in percent ischemic myocardium at follow-up stress MPI. All MPI images were processed and analyzed at a central core lab, blinded to treatment allocation. ResultsIn all, 109 patients were enrolled from nine countries. In the ischemia-guided arm, 25/48 (47%) patients underwent non-culprit vessel PCI following stress MPI. In the routine non-culprit PCI arm, 43/56 (77%) patients underwent angioplasty (86% within 6 weeks of randomization). The median percentage of ischemic myocardium on follow-up imaging (mean 16.5 months) was low, and identical (2.9%) in both arms (difference 0.13%, 95%CI − 1.3%–1.6%, P < .0001; non-inferiority margin 5%). ConclusionA strategy of ischemia-guided non-culprit PCI resulted in low ischemia burden, and was non-inferior to a strategy of routine non-culprit vessel PCI in reducing ischemia burden. Selective non-culprit PCI following STEMI offers the potential for cost-savings, and may be particularly relevant to low-resource settings.(CTRI/2018/08/015384).

Microvascular and Prognostic Effect in Lesions With Different Stent Expansion During Primary PCI for STEMI: Insights From Coronary Physiology and Intravascular Ultrasound.

BackgroundWhile coronary stent implantation in ST-elevation myocardial infarction (STEMI) can mechanically revascularize culprit epicardial vessels, it might also cause distal embolization. The relationship between geometrical and functional results of stent expansion during the primary percutaneous coronary intervention (pPCI) is unclear.ObjectiveWe sought to determine the optimal stent expansion strategy in pPCI using novel angiography-based approaches including angiography-derived quantitative flow ratio (QFR)/microcirculatory resistance (MR) and intravascular ultrasound (IVUS).MethodsPost-hoc analysis was performed in patients with acute STEMI and high thrombus burden from our prior multicenter, prospective cohort study (ChiCTR1800019923). Patients aged 18 years or older with STEMI were eligible. IVUS imaging, QFR, and MR were performed during pPCI, while stent expansion was quantified on IVUS images. The patients were divided into three subgroups depending on the degree of stent expansion as follows: overexpansion (>100%), optimal expansion (80%−100%), and underexpansion (<80%). The patients were followed up for 12 months after PCI. The primary endpoint included sudden cardiac death, myocardial infarction, stroke, unexpected hospitalization or unplanned revascularization, and all-cause death.ResultsA total of 87 patients were enrolled. The average stent expansion degree was 82% (in all patients), 117% (in overexpansion group), 88% (in optimal expansion), and 75% (in under-expansion). QFR, MR, and flow speed increased in all groups after stenting. The overall stent expansion did not affect the final QFR (p = 0.08) or MR (p = 0.09), but it reduced the final flow speed (−0.14 cm/s per 1%, p = 0.02). Under- and overexpansion did not affect final QFR (p = 0.17), MR (p = 0.16), and flow speed (p = 0.10). Multivariable Cox analysis showed that stent expansion was not the risk factor for MACE (hazard ratio, HR = 0.97, p = 0.13); however, stent expansion reduced the risk of MACE (HR = 0.95, p = 0.03) after excluding overexpansion patients. Overexpansion was an independent risk factor for no-reflow (HR = 1.27, p = 0.02) and MACE (HR = 1.45, p = 0.007). Subgroup analysis shows that mild underexpansion of 70%−80% was not a risk factor for MACE (HR = 1.11, p = 0.08) and no-reflow (HR = 1.4, p = 0.08); however, stent expansion <70% increased the risk of MACE (HR = 1.36, p = 0.04).ConclusionsStent expansion does not affect final QFR and MR, but it reduces flow speed in STEMI. Appropriate stent underexpansion of 70–80% does not seem to be associated with short-term prognosis, so it may be tolerable as noninferior compared with optimal expansion. Meanwhile, overexpansion and underexpansion of <70% should be avoided due to the independent risk of MACEs and no-reflow events.

The benefit of complete revascularization after primary PCI for STEMI is attenuated by increasing age: Results from the DANAMI-3-PRIMULTI randomized study.

To ascertain the effect of age on outcomes after culprit-only and complete revascularization after Primary PCI (PPCI) for ST-elevation myocardial infarction (STEMI). The numbers of older patients being treated with PPCI are increasing. The optimal management of nonculprit stenoses in such patients is unclear. We conducted an analysis of patients aged ≥75 years randomized in the DANAMI-3-PRIMULTI study to either culprit-only or complete FFR-guided revascularization. The primary endpoint was a composite of all-cause mortality, nonfatal reinfarction, and ischaemia-driven revascularization of lesions in noninfarct-related arteries after a median of 27 months of follow-up. One hundred and ten of six hundred and twenty seven patients in the DANAMI-3-PRIMULTI trial were aged ≥75 years. These patients were more likely female (p < .001), hypertensive (p < .001), had lower hemoglobin levels (p < .001), and higher serum creatinine levels (p < .001) than the younger patients in the trial. Other than less use of drug-eluting stents (96.6 versus 88.0%: p = .02), there were no significant differences in procedural technique and success between patients aged <75 years and those ≥75 years of age. There was no significant difference in the incidence of the primary endpoint in patients ≥75 years randomized to culprit-only or FFR-guided complete revascularization (HR 1.49 [95% CI 0.57-4.65]; log-rank p = .19; p for interaction versus patients <75 years <.001). There was a significant interaction between age as a continuous variable, treatment assignment, and the primary outcome (p < .001); beyond the age of about 75 years, there may be no prognostic advantage to complete revascularization. In patients ≥75 years, after treatment of the culprit lesion in STEMI, there is no significant prognostic benefit to prophylactic complete revascularization of nonculprit stenoses. Pending further study, data would support a symptom-guided approach to further invasive treatment.

Impact of Routine 24 Hour Coronary Care Unit Stay in Stable Patients After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

With the routine use of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), the rate of short-term complications is low and the optimal length-of-stay in the coronary care unit (CCU) following reperfusion is unknown. We hypothesized that the rate of complications would not differ between two groups of stable patients admitted to the CCU following primary-PCI for STEMI: (1) those for whom a minimum 24-hour stay was enforced (≥24 hour Standard Stay) and (2) those with no minimum length-of-stay (Physician-guided Stay). Data were collected retrospectively. We performed a regression analysis to determine predictors of the primary endpoint (a composite of in-hospital death, re-infarction and/or re-intervention, heart failure requiring intravenous diuretics, cardiac arrest, central nervous system and/or peripheral embolization, bleeding requiring transfusion, arrhythmia resulting in initiation of a class I or III antiarrhythmic drug, initiation of assisted ventilation, requirement for vasopressors or inotropes, or transfer to intensive care). A total of 242 patients were included in the analysis. The rate of the primary endpoint was 8% in the physician-guided stay group and 16% in the standard ≥24 hour stay group (p = 0.06). The most common complication in both groups was heart failure requiring diuretics (42%), which was predicted by the left ventricular end diastolic pressure on catheterization (area under the Receiver-Operator Curve of 0.75). In conclusion, Patients who are stable following primary PCI for STEMI have a low rate of complications. Stable STEMI patients do not appear to benefit from a mandatory ≥24 hours stay in the CCU.

Bare metal versus drug eluting stents for ST-segment elevation myocardial infarction in the TOTAL trial

BackgroundThe safety and efficacy of drug eluting stents (DES) in the setting of ST elevation myocardial infarction (STEMI) is not well established. MethodsIn the TOTAL trial, patients presenting with STEMI were randomized to routine thrombectomy versus PCI alone. In this post-hoc analysis, propensity matching was used to assess relative safety and efficacy according to type of stent used. ResultsEach propensity-matched cohort included 2313 patients. The composite primary outcome of cardiovascular death, recurrent MI, cardiogenic shock or class IV heart failure within one year was lower in the DES group (HR 0.67; 95% CI 0.54 to 0.84, p=0.0004). Cardiovascular death (HR 0.61; 95% CI 0.43 to 0.86, p=0.005), recurrent MI (HR 0.51; 95% CI 0.35 to 0.75, p=0.0005), target vessel revascularization (HR 0.47; 95% CI 0.36 to 0.62, p<0.0001) and stent thrombosis (HR 0.60; 95% CI 0.40 to 0.89, p=0.01) were lower in the DES group. There was no difference in major bleeding between groups. ConclusionsIn this observational analysis, the use of DES was associated with improvement in cardiovascular outcomes compared to the use of BMS. These results support the use of DES during primary PCI for STEMI.

Early changes of left ventricular filling pattern after reperfused ST-elevation myocardial infarction and doxycycline therapy: Insights from the TIPTOP trial

AimMetalloproteinases inhibition by doxycycline reduces cardiac protein degradation at extracellular and intracellular level in the experimental model ischemia/reperfusion injury. Since both extracellular cardiac matrix and titin filaments inside the cardiomyocyte are responsible for the myocardial stiffness, we hypothesized that doxycycline could favorably act on left ventricular (LV) filling pressures in patients after reperfused acute ST-elevation myocardial infarction (STEMI). Methods and resultsSeventy-three of 110 patients of the TIPTOP trial underwent a 2D-Echo-Doppler on admission, and at pre-discharge and at 6-month after a primary PCI for STEMI and LV dysfunction. From admission to pre-discharge, LV filling changed from a high filling pressure (HFP) to a normal filling pressure (NFP) pattern in 91% of the doxycycline-group, and in 67% of the control-group. Conversely, 1% of the doxycycline-group, and 37% of the control-group changed the LV filling from NFP to HFP pattern. Overall, a pre-discharge HFP pattern was present in 4 patients (11%) of the doxycycline-group and in 13 patients (36%) of the control-group (p=0.025). The evaluation of metalloproteinases and their tissue inhibitors plasma concentrations provide possible favorable action of doxycycline. On the multivariate analyses, troponine I peak (p=0.026), doxycycline (p=0.033), and on admission to pre-discharge LVEF changes (p=0.044) were found to be associated with pre-discharge HFP pattern. Independently of their baseline LV filling behavior, the 6-month remodeling was less in patients with pre-discharge NFP pattern than in patients with HFP pattern. ConclusionsIn patients with STEMI and LV dysfunction doxycycline can favorably modulate the LV filling pattern early after primary PCI.

When the Innocent Bystander Becomes the Culprit: Two Episodes of STElevation Myocardial Infarction with Different Culprit Coronary Arteries in A Single Patient Occurring Two Days a Part

Background: Recurrent ST elevation myocardial infarction (STEMI) with different culprit lesions in a single patient occurring few days apart is uncommon with limited similar cases reported. Case Presentation: This is a case of a 53-year-old male who presented to the Emergency Department with left upper quadrant abdominal pain and an initial electrocardiogram showing ST elevation MI in the anterolateral leads. He underwent successful primary angioplasty of the culprit lesion (LAD) with placement of a single Everolimus drug-eluting stent with plans for staged intervention within a month of the remaining severe lesion in the left circumflex (LCx) artery (non-infarct related vessel). Two days after the initial STEMI, the patient experienced recurrence of abdominal pain with hypotension, and a repeat ECG revealed new ST segment elevation in the inferior leads. A repeat coronary angiogram demonstrated a widely patent stent in the LAD and the previously noted diseased LCx. No other new lesions were noted and the RCA was also patent. The patient then underwent a successful second primary PCI of the previously untreated severe lesion in the LCx. Conclusion: Consecutive episodes of acute myocardial infarction in different coronary arteries occurring within hours to a few days after primary PCI for STEMI is uncommon and can be catastrophic if not detected early. The mechanism and predisposing factors to such event are still unclear. The optimum interventional treatment strategy regarding the immediate management of STEMI in patients with multi-vessel disease remains controversial.

Identifying patients for safe early hospital discharge following st elevation myocardial infarction.

To examine whether the CADILLAC risk score is an effective method of patient stratification for early discharge following ST elevation myocardial infarction (STEMI). Patients with STEMI are typically hospitalized to monitor for serious complications such as arrhythmias, heart failure, and reinfarction. Optimal length of stay is unclear. Whether low risk patients can be safely discharged before 72 hr of hospitalization is unclear. Patients with STEMI who underwent successful PCI were retrospectively stratified using CADILLAC risk score to low risk (n = 123) and intermediate to high risk (n = 105). The primary outcome was adverse clinical events at day 3 or later. Secondary outcomes were adverse clinical events on day 1 and mortality rates at 30 days and 31 to 365 days. Low risk patients had lower major adverse clinical events at day 3 or later (0 vs. 11.4%, P = 0.0002) and lower total mortality at 1 year (0 vs. 4.8%, P = 0.02) than patients with intermediate to high risk. Low risk patients were also less likely to have a cardiovascular event during the first 24 hr when compared to those with an intermediate to high risk score (3.3% vs. 13.3%, P = 0.006). Low risk patients identified using CADILLAC risk score with STEMI treated successfully with primary PCI have a low adverse event rate on the third day or later of hospitalization suggesting that an earlier discharge is safe in properly selected patients. Monitoring in a noncritical care setting following primary PCI for STEMI may be feasible for selected patients. © 2016 Wiley Periodicals, Inc.

44 Multi-vessel PCI in STEMI after the PRAMI trial: the Irish experience

Prior to the publication of the PRAMI trial the guideline recommendation was to only undertake culprit vessel PCI at the time of Primary PCI (PPCI) in the management of ST elevation myocardial infarction (STEMI). The guidelines advocated a staged PCI approach. The benefit of non-culprit PCI at the time PPCI is now widely accepted in the post PRAMI era. We reviewed all patients that underwent PPCI for STEMI in St James in 2015 to examine our practice in this regard. We recorded the number of patients that underwent multi-vessel PCI (MVPCI) at the time of infarct artery PCI compared with the group that underwent staged PCI and those referred for CABG. We looked at different parameters that may affect decision-making at the time of PPCI such as primary operator and ‘on-call hours’ to see if these variables influenced the decision to proceed or wait. Patient mortality and length of stay (LOS) were also compared between the groups. We used the Code STEMI database and HIPE data to identify our patient cohort, with review of the patient chart to verify missing details. In 2015 there were 487 patients diagnosed with a STEMI in SJH or transferred to St James as part of the National ACS programme (average age 62.2 years (range 23–91), 25% female). There were 407 (83.6%) patients with a confirmed diagnosis of STEMI, either clinically or angiographically (average age 62.4 years, 25% female). 375 (77%) had PPCI (average age 61.5 years, 23% female). 53 patients had MVPCI at the same time as PPCI (14%, average age 61, 21% female). 58 had staged PCI (15%, average age 62, 17% female); 18 as an inpatient, 36 as an outpatient and for 4 patients it was recommended on repatriation to a PCI centre. LOS in those not repatriated to their local hospital was 8.4 days (median 6.8, range 4.4–17.7) in MVPCI and 8.3 (median 6.3, range 3.3–26.2) in the staged PCI group. The MVPCI group had an inpatient mortality of 3.7% (2 patients), there were no recorded deaths in staged PCI subgroup. The majority of all the cases were performed during ‘on-call hours’; MVPCI 64.5% and staged 61.4%. Out of 10 primary operators only one displayed a statistically significant preference for MVPCI versus staged PCI (p In the largest Irish PPCI centre we found the number of patients undergoing non-culprit vessel PCI at the time of PPCI is much larger than those undergoing inpatient staged PCI. There was no reduction in length of stay in our cohort. The prolonged LOS and the mortality rate may reflect the more complex disease in the cohort undergoing MVPCI and also reflect that this is real-life data including patients in cariogenic shock and post cardiac arrest.

TCT-520 Real-world Clinical Outcomes of Bioresorbable Vascular Scaffold Versus Conventional Drug Eluting Stents in Primary-PCI for ST-elevation Myocardial Infarction: single center one-year experience

TCT-520 Real-world Clinical Outcomes of Bioresorbable Vascular Scaffold Versus Conventional Drug Eluting Stents in Primary-PCI for ST-elevation Myocardial Infarction: single center one-year experience

Infarct Related Artery only Versus Multivessel Revascularization during Primary PCI for STEMI

Background: Guidelines for ST Elevation Myocardial Infarction (STEMI) recommend for multivessel disease that only the culprit vessel be treated and that other diseased vessels be addressed in another time. Methods: STEMI patients with multivessel disease undergoing primary PCIs in our center between January 2001 and April 2011 were divided into: 1- Culprit only PCI and 2- Multivessel PCI during the index procedure. Mortality rates and clinical outcomes were compared between the two groups in hospital and at 12 months. Results: 491 patients had STEMI and multivessel disease. In 341 (69.5%) immediate multivessel PCI was performed, in 150 (30.5%) patients a culprit vessel only was treated and the rest was deferred for another procedure. Multivessel PCI was associated with Shorter hospitalization (4.4 ± 1.27 versus 7.6 ± 2.1, P=0.01), reduced incidence of 12 months major adverse cardiac events (recurrent ischemia, reinfarction, acute heart failure and mortality (16.1 versus 35.3%, P=0.01). A significant lower rate of recurrent ischemic episodes (5.6% versus 11.3%, P=0.02), myocardial reinfarction (5% versus 10%, P=0.01), reintervention (9.4% versus 26%, P=0.01). Transient renal dysfunction was more common in multivessel PCI (8.5% versus 4% P=0.01). In-hospital mortality (4.1% vs 4.4% p=0.9) was similar, while 1 year mortality tended to be decreased in the multivessel group (6.9% vs 7.4%), p=0.06). Conclusion: Multivessel revascularization resulted in an improved clinical course. Our findings support that multivessel PCI during STEMI can be feasible and safe. Decisions about PCI of the non-infarct vessel(s) should be individualized. Further large, randomized trials will help us solve this dilemma.

Value of admission glucose to predict impaired coronary microcirculation in acute ST-elevation myocardial infarction

Background: Acute hyperglycemia is frequently observed in non-diabetic ST-elevation myocardial infarction (STEMI) patients. It is thought to be associated with the release of stress-mediators like noradrenalin and cortisol, which antagonize insulin and promote glycogenolysis and hyperglycemia, or with the high incidence of impaired glucose tolerance among STEMI patients. Hyperglycemia recently was shown to be associated with the no-reflow phenomenon, which is mainly a manifestation of microvascular dysfunction. We recently showed that no-reflow (or not achieving TIMI 3 flow) with primary PCI for STEMI had independent prognostic value with regard tot 30-day, as well as 1-year mortality, next to admission glucose. Although no reflow in this study was an indirect measure of microvascular dysfunction, the significant association between no-reflow and increasing admission glucose and the attenuation of the effect of no-reflow by glucose concentration in multivariate analysis indicate the role of acute hyperglycemia in the pathophysiology of microvascular dysfunction. Methods: In 76 patients with a first anterior wall STEMI, baseline and minimal microvascular resistance in IRAs and non-IRAs immediately after reperfusion and at 1-week and 6-month follow-up were calculated as the ratio of mean transvascular pressure gradient to mean baseline and to adenosine-induced hyperemic blood flow velocity, respectively. Patients were divided in two groups, glucose below 11.0 mmol/L (group A) and glucose equal or higher than 11 mmol/L (group B), according to a cut-off level of the American Diabetes Association and the Euro Heart Survey. Results: Minimum microvascular resistance, defined as the ratio of mean distal pressure to average peak blood flow velocity during maximum hyperemia, showed a large variability (overall range, 0.75 to 4.89 mm Hg cm-1 s-1) and was significantly higher in group B than in group A immediately after reperfusion and at 1-week. Conclusion: In conclusion, minimal microvascular resistance is higher in anterior STEMI patients with hyperglycemia equal or above 11.0 mmol/L compared to patients with glucose leven lower than 11.0 mmol/L. Hyperglycemia in STEMI patients could prove to be an important predictor of microvacular dysfunction and obstruction.

ST elevation myocardial infarction treated with bioresorbable vascular scaffold: rationale and first cases

Bioresorbable vascular scaffolds (BVS) have the potential to start new era in interventional cardiology. First clinical studies in stable coronary artery disease have demonstrated a good safety profile and promising results. The use of BVS in ST elevation myocardial infarction (STEMI) has not yet been reported. The first two implantations of BVS Absorb® during primary PCI for STEMI in humans performed at our institution in December 2012 are described. Both patients have given written informed consent. The first patient, a 54-year-old male, …

How Should We Treat Multi-Vessel Disease in STEMI Patients?

Primary angioplasty of the culprit coronary artery lesion is the preferred reperfusion strategy for ST-elevation myocardial infarction (STEMI) when timely access to a catheterization laboratory is available. The presence of multi-vessel disease (MVD) in patients undergoing primary PCI is common, occurring in about 40%-50% of patients. The presence of MVD in patients who have undergone successful primary PCI substantially increases the risks of mortality and major adverse cardiac events, such as reinfarction or need for urgent revascularization. The current evidence supporting revascularization of non-culprit lesions is sparse, with no large, adequately powered randomized trials to guide clinical practice. An analysis combining observational data and small randomized trials suggests that complete revascularization with PCI to significant non-culprit lesions may afford a benefit compared with medical management alone. However, this benefit appears to be confined to when revascularization is performed as a separate, staged procedure. By contrast, when non-culprit lesion PCI is performed during the initial primary PCI procedure, the risk of death or cardiovascular events is higher than medical management alone or to staged revascularization. A large, adequately powered randomized trial is urgently needed to determine whether routine staged PCI plus optimal medical therapy is superior to optimal medical therapy alone for significant non-culprit coronary artery lesions in patients who have undergone successful primary PCI for STEMI.

Abstract 300: Race/Ethnicity Is Not Associated with Longer Door to Balloon Time or Increased Mortality in Patients Undergoing Primary PCI for STEMI: Findings from AHA-GWTG

Introduction: In patients with ST-Elevation Myocardial Infarction (STEMI) treated with PCI, door to balloon time (DTB) of ≤ 90 minutes is associated with improved outcomes. We sought to compare DTB between patients of different race/ethnicity undergoing primary PCI in Get With The Guidelines (GWTG) hospitals. Methods: We analyzed the GWTG registry to identify patients treated with primary PCI for STEMI within 24 hours of presentation between 2005-2009. Patients treated with fibrinolytics, transferred to the hospital for PCI, or those missing DTB were excluded. Baseline demographics, median DTB, proportion of patients with DTB ≤ 90 minutes, and in-hospital mortality were compared between groups: White, African American, Hispanic. Results: Of the 7824 patients, 85% were White (n=6666), 8% were African American (n=607) and 7% were Hispanic (n=551). When compared with Whites and Hispanics, African American were younger but had higher rates of smoking, hypertension, renal disease, prior myocardial infarction, heart failure, or stroke. The Hispanic group had a higher proportion of patients with diabetes, hyperlipidemia, and no insurance. Median DTB times and the proportion of patients treated ≤ 90 minutes were similar between the three groups (Figure). In-hospital mortality was similar in the groups: white (3.8%), African American (3.0%), and Hispanic (3.8%); p=0.62. Conclusion: Within the context of a national quality improvement initiative, race/ethnicity was not associated with either DTB or in-hospital mortality among STEMI patients undergoing PCI. This suggests that programs such as GWTG may reduce race/ethnicity based disparities in the care of patients with STEMI.

9 Early hospital discharge at 48 h following primary PCI for myocardial infarction is both safe and feasible

<h3>Introduction</h3> Reperfusion therapy with primary PCI (PPCI) has reduced rates of recurrent ischaemia and arrhythmia following ST elevation myocardial infarction (STEMI), resulting in shorter hospital stays. Discharge at 72 h in selected patients has been suggested. We investigated the feasibility and safety of very early discharge (&lt;48 h) coupled with regular outpatient support for low-risk patients following PPCI. <h3>Methods</h3> 2317 patients underwent PPCI for STEMI between October 2003 and May 2010 at a regional Heart Attack Centre (HAC). Demographic and procedural data were documented at the time of intervention. Patients with TIMI 3 flow, ST segment resolution, good or moderate left ventricular function, and no dysrhythmia were stratified to 48 h discharge. Remaining patients were discharged according to physician preference. All patients were reviewed at 1, 8 and 52 weeks with a multidisciplinary team including rehabilitation, heart failure, and psychology. The primary endpoint was major adverse cardiac events (MACE) included death, myocardial infarction (MI), stroke and target vessel revascularisation (TVR). All-cause mortality data were provided by the Office of National Statistics via the BCIS CCAD national audit. Outcomes were compared between those discharged at ≤48 h, 72 h, and &gt;72 h, out to 5 years of follow-up. <h3>Results</h3> 1079 patients (46.5%) were stratified to 48-h discharge, 14% discharged at 72 h and the remainder discharged at a median of 6 days (4.3–10), including those with complications. Patients discharged at ≤48 h were significantly younger and had a lower incidence of multi-vessel disease than those discharged at 72 h (Abstract 9 table 1). Remaining baseline characteristics were similar. MACE at 3 years was similar between 48-h discharge patients and 72- h discharge (9.1% vs 8.7%, p=0.7). This persisted out to 5 years (9.6% vs 9%, p=0.55). As expected patients with length of stays &gt;72 h had significantly worse outcomes (Abstract 9 figure 1). <h3>Conclusion</h3> Early discharge at 48 h is feasible and appears to be safe for patients undergoing contemporary Primary PCI.

THE USE OF BARE-METALS STENTS IN PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ACUTE MYOCARDIAL INFARCTION: IS THERE A DIFFERENCE IN CLINICAL OUTCOME BETWEEN COBALT CHROMIUM VERSUS STAINLESS STEEL STENTS?

Background: The use of DES results in lower risk of target vessel revascularization (TVR) compared to bare metal stents (BMS) following primary PCI for patients with acute ST-elevation myocardial infarction (STEMI). However, BMS are more commonly implanted compared to DES due to concerns of poor compliance to dual antiplatelet therapy, risk of late stent thrombosis and increased cost. Newer generation BMS based on cobalt chromium alloy have thinner stent struts, better deliverability and potentially lower rates of TVR compared with conventional stainless steel BMS. Therefore we aim to determine the clinical outcome and rates of TVR in patients undergoing primary PCI for STEMI who were treated with cobaltchromium stents compared to stainless steel stents.