Differential effects of post-dilation after stent deployment in patients presenting with and without acute myocardial infarction

Abstract

Background In the practice of percutaneous coronary intervention (PCI), post-dilatation often is performed after stent deployment to improve stent expansion. However, aggressive mechanical expansion is a risk factor of distal embolization and microvascular injury, especially for patients with acute myocardial infarction (AMI). Few studies have investigated the effects of post-dilatation on medium-term clinical outcomes. Methods and Results Patients enrolled in the multicenter NHLBI Dynamic Registry between 2001 and 2006 were evaluated. Patients who were treated with ≥1 stent were studied. Patients with cardiogenic shock or history of coronary artery bypass graft surgery were excluded. Patients were followed up to 1 year. Because of the significant statistical interaction (P = .02) between post-dilatation and AMI status on the hazard of death/myocardial infarction (MI), post-dilatation effects were estimated separately for patients who did and did not present with an AMI. Among the 1,358 patients who presented with an AMI, post-dilatation was associated with a significantly higher risk of death/MI (hazard ratio [HR] = 1.78, 95% CI 1.12-2.83, P = .01), not associated with the risk of repeat revascularization (HR = 1.15, 95% CI 0.81-1.62, P = .43). Among the 2,699 patients who did not present with AMI, post-dilatation was not associated with risks of death/MI (HR = 1.08, 95% CI 0.77-1.50, P = .67) or repeat revascularization (HR = 1.17, 95% CI 0.93-1.47, P = .19). Similar effects were observed for the restricted analysis with additional adjustment for lesion characteristics among the 1,039 AMI patients and 2,179 non-AMI patients with a single lesion treated. Conclusions Stent post-dilatation is associated with an increased risk of death/MI in AMI patients but not in non-AMI patients. Further investigation is warranted.

Angiographic and Clinical Outcomes of Stent Postdilatation in ST-Elevation Myocardial Infarction

“…In terms of stent type, there Our findings reassure us that in the current era of primary PCI for STEMI, stent postdilatation is justifiable if angiographically indicated to optimise stent deployment. Nonetheless, the results of our study differed from those of a recently published study by Zhang et al [5] looking at the effects of postdilatation in patients who presented with and without AMI, between 2001 and 2006 in the NHLBI Dynamic Registry. The authors found that postdilatation was associated with an increased risk of death and repeat MI in patients who presented with AMI.…”

Is Postdilatation with a Noncompliant Balloon Necessary after Coronary Stent Deployment during Primary Angioplasty?

“…PD has been recommended to overcome these complications and provide optimal stent expansion in elective PCI . However, there is no consensus among interventional cardiologists regarding performance of PD during primary PCI, due to limited data and a general lack of evidence …”

“…Dilatation with a noncompliant (NC) balloon after stent deployment, to provide optimal expansion, reduced the target vessel revascularization (TVR) rate and resulted in better angiographic results and clinical outcomes in patients undergoing elective PCI . However, there is no consensus among interventional cardiologists regarding performance of postdilatation (PD) in primary PCI . In this study, we sought to evaluate the effects of PD on postprocedural angiographical and 6‐month clinical outcomes in patients who underwent primary PCI with a DES.…”

“…[10][11][12] However, there is no consensus among interventional cardiologists regarding performance of postdilatation (PD) in primary PCI. 13,14 In this study, we sought to evaluate the effects of PD on postprocedural angiographical and 6-month clinical outcomes in patients who underwent primary PCI with a DES.…”

Changes of Plasma B-Type Natriuretic Peptide Levels after High-Pressure Post-Dilation following Coronary Stent Deployment

“…In addition, some reports showed that among patients with acute myocardial infarction, post-dilation was associated with a significantly higher risk of death/myocardial infarction but not associated with the risk of repeat revascularization. Whereas, among patients who did not present with acute myocardial infarction, post-dilation was not associated with risks of death/myocardial infarction or repeat revascularization[11],[12]. However, no data are currently available to clarify whether the high-pressure post-dilation has an adverse effect on short-term cardiac function in patients without acute myocardial infarction.…”