Deflated Balloon-Facilitated Direct Stenting in Primary Angioplasty (The DBDS Technique): A Pilot Study

Abstract

BackgroundSeveral studies and meta-analyses have shown that direct stenting (DS) may improve clinical outcomes in patients with acute ST-elevation myocardial infarction (STEMI). But in most cases, the thrombolysis in myocardial infarction (TIMI) flow remains ≤ 1 after wire placement. We used deflated balloon to facilitate DS in patients with totally occluded culprit arteries. The aim of this study was to evaluate the feasibility, safety and outcomes of this novel technique in patients with STEMI in real-world clinical practice.MethodsThis was a prospective, observational, single-center pilot study. From September 2016 to June 2018, 454 patients were enrolled in the study. DS was performed when the culprit vessel was visualized with at least TIMI flow grade 1. Patients with complete occlusion of the vessel after wire placement were subjected to deflated balloon-facilitated DS technique (DBDS technique) and DS was done wherever possible.ResultsDS was done in 74% (n = 336) of the patients and 26% (n = 118) patients received stenting after pre-dilatation (PD). DBDS technique to facilitate DS was successful in 68% patients (211/309). Final TIMI 3 flow was achieved more frequently in the DS group as compared to PD group (96.7% versus 92.3%, P = 0.04). The procedural complications were also significantly lower in DS group (0.6% versus 7.6%, P < 0.001). DS group had significantly lower procedure time (33 ± 19 min versus 41 ± 17 min, P < 0.001), fluoroscopy time (6.2 ± 3.4 min versus 7.8 ± 32 min, P < 0.001), required lesser contrast volume (112 ± 16 mL versus 123 ± 18 mL, P < 0.001) and had lower procedural cost (310 ± 45$ versus 402 ± 56$, P < 0.001). ST-segment resolution > 50% after percutaneous coronary intervention (PCI) were significantly higher in the DS group (85.7% versus 71.1%, P < 0.001). At 30 days, the major adverse cardiac event (MACE) rate was significantly lower in the DS group (2.4% versus 9.3%, P = 0.02), mainly driven by lower rates of target lesion revascularization (TLR) (0.9% versus 4.2%, P = 0.01).ConclusionThis cost-effective technique appears to be simple, feasible and safe and is associated with superior clinical outcomes. It helps in maximizing DS and could offer an alternative to PD and aspiration thrombectomy in total occlusion. However, larger studies with longer follow up are required before a wider application of this technique.

Real World Experience of a Biodegradable Polymer Sirolimus-Eluting Stent (Yukon Choice PC Elite) in Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Angioplasty: A Multicentric Observational Study (The Elite India Study)

“…More recently, the 5-year follow-up of EXAMINATION trial demonstrated a reduction in the patient-oriented endpoints, device-oriented endpoints, stent thrombosis and all-cause mortality with DES [37]. Stenting with new-generation DES is thus recommended over BMS for primary PCI [2]. The results of the present study confirm these findings with a favourable 1-year safety and efficacy profile.…”

“…Major and minor bleeding was defined using the Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria [22]. Obesity was defined as body mass index > 25 kg/m2 [23].…”

“…Primary percutaneous coronary intervention (PCI) is considered the gold standard of management in ST-segment elevation myocardial infarction (STEMI) [1], [2]. Coronary stenting with a bare-metal stent (BMS) is associated with a lower risk of reinfarction and target vessel revascularisation compared with balloon angioplasty alone [3].…”

Comparison of Contrast Enhanced Low-Dose Dobutamine Stress Echocardiography with 99mTc-Sestamibi Single-Photon Emission Computed Tomography in Assessment of Myocardial Viability

“…In patients with severe coronary artery disease and a low LVEF, the evaluation of viability in regions with chronic contractile dysfunction has been shown to predict improvement of function after revascularization [2], [3], [4], [5], [6], [7], [8], [24], [25]. The current study was done to compare the most widely available and commonly used modalities, i.e.…”

“…However, reports show that > 50% of such patients may have viable myocardium [1]. Revascularization improves left ventricular ejection fraction (LVEF), heart failure symptoms and prognosis predominantly in patients with viable myocardium [2], [3], [4], [5], [6], [7], [8]. Though some recent studies provided contrary results, they had several significant limitations and confounding factors [9], [10].…”