Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

A comparison of direct versus conventional stenting in patients undergoing primary angioplasty for ST-elevation myocardial infarction

Isik, Turgaya; Ayhan, Erkana; Uyarel, Huseyinb; Ergelen, Mehmetb; Cicek, Gokhanc; Osmonov, Damirbekc; Turkkan, Ceyhanc; Turer, Aycac; Ghannadian, Bahmand; Eren, Mehmetc

doi: 10.1097/MCA.0b013e3283548862
Therapy and Prevention
Buy

Objective The aim of our study was to determine the impact of direct stenting (DS) on procedural success and the in-hospital outcome among patients with ST-elevation myocardial infarction (STEMI) treated with a primary percutaneous coronary intervention (PCI).

Background With improvements in stent designs, DS has become more widespread. The theoretical advantages of DS include a shorter procedural time, a lower contrast dose, and reduced spiral dissections, along with reduced radiation exposure and procedural costs.

Methods A total of 1992 consecutive STEMI patients were reviewed; 621 patients (31.2%) were included in the DS group and 1371 (68.8%) in the conventional stenting (CS) group. The clinical and angiographic characteristics, in-hospital outcomes, and predictors of unsuccessful primary angioplasty were analyzed.

Results The incidence of in-hospital major adverse cardiac events (MACE) was 6.1% in the CS group and 4.3% in the DS group. The difference between the two patient groups was not statistically significant for myocardial reinfarction (re-MI), target-vessel revascularization, and MACE. Nonetheless, the rates of in-hospital mortality and advanced heart failure were significantly lower in the DS group. CS [odds ratio (OR) 3.49, 95% confidence interval (CI) 1.65–7.37, P=0.001], Killip class 2/3 (OR 2.5, 95% CI 1.2–5.23, P=0.01), glomerular filtration rateless than 60 ml/min/1.73 m2 (OR 2.2, 95% CI 1.22–3.94, P=0.008), and anterior MI (OR 1.61, 95% CI 1.01–2.56, P=0.04) were found to be independent predictors of unsuccessful procedures.

Conclusion DS improves the in-hospital outcomes of STEMI patients treated with primary PCI, particularly by reducing the rates of in-hospital mortality and advanced heart failure. CS was an independent predictor of unsuccessful PCI.

aDepartment of Cardiology, School of Medicine, Balikesir University, Balikesir

bDepartment of Cardiology, School of Medicine, Bezmialem Vakif University

cDepartment of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey

dDepartment of Cardiology, California University School of Medicine, San Diego, California, USA

Correspondence to Turgay Isik, MD, Department of Cardiology, School of Medicine, Balikesir University, Cagis Campus, Balikesir 25100, Turkey Tel: +90 266 612 1455; fax: +90 266 612 1459; e-mail: isikturgay@yahoo.com

Received November 29, 2011

Accepted April 3, 2012

© 2012 Lippincott Williams & Wilkins, Inc.