Comparison of Outcomes of Direct Stenting Versus Stenting After Balloon Predilation in Patients With Acute Myocardial Infarction (DIRAMI)

Direct Stenting Versus Pre‐Dilation in ST‐Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

“…Figure shows the result of our search strategy. Of the 357 reports initially identified, 3 RCTs and 9 NRSs were included in this meta‐analysis, for a total sample size of 9,331 patients (n = 473 for RCTs and n = 8,858 for NRSs), of whom 2,933 (31.4%) were treated with DS. Inter‐reviewer agreement for study inclusion was 100%.…”

“…Angiographically, patients treated with DS had better initial TIMI flow. DS success rate was high, since the bailout SP rates were comprised between 2% and 12% . The use of fibrinolytic agents prior to PCI was variable, ranging from 0% (exclusion criterion) to 100% …”

“…No differences in stent thrombosis at one year were observed in the HORIZONS‐AMI substudy . However, a higher rate of restenosis was found in DS group at one year by Gasior et al The increasing use of drug‐eluting stents in STEMI could potentially address this problem.…”

Stent direto na intervenção coronária primária: avaliação de seu uso na prática clínica contemporânea

“…Esse achado é compatível com os resultados relatados no presente estudo, em que somente um terço dos pacientes foi tratado com stent direto. Por outro lado, no ensaio clínico randomizado realizado por Gasior et al 21 , o stent direto não demonstrou benefício clínico ou angiográfico, e esteve associado a maiores taxas de reestenose no seguimento clínico tardio. Esse desfecho desfavorável poderia estar relacionado ao subdimensionamento do stent em relação ao real diâmetro do vaso, em virtude da vasoconstrição, espasmo e trombose associados ao infarto agudo do miocárdio com supradesnivelamento do segmento ST.…”

Serum B-type natriuretic peptide on admission can predict the ‘no-reflow’ phenomenon after primary drug-eluting stent implantation for ST-segment elevation myocardial infarction

“…Furthermore, drug-eluting stent (DES) appears further to reduce the rate of target-vessel revascularization within 12 months compared to using an uncoated stent [5,6]. PPCI restores normal angiographic flow in occluded arteries in more than 90% of cases, but no-reflow phenomenon cannot be evitable in some cases [7,8]. Because angiographic 'no-reflow' phenomenon is associated with a poor short-term and long-term prognosis, the risk of a major adverse event could be as high as 10 times that of a historical control [7,9].…”