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

Azzalini, Lorenzo; Millán, Xavier; Ly, Hung Q.; L’Allier, Philippe L.; Jolicoeur, Marc

doi:10.1111/joic.12190

Cited by 30 publications

(18 citation statements)

References 50 publications

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“…But additional balloon dilatation may also increase the risk of MVO through distal embolization of thrombotic material. 21,22 Moreover, the rate of postdilatation was lower in the DS versus the IS group (57.7% versus 71.4%) in DEFER-STEMI, and this might have had a confounding effect to explain the higher rate of angiographic slow-reflow in the IS group in this study. 11 In the MIMI study, the rates of pre-and postdilatation in the IS versus DS group were 11.0% and 15.1%, respectively.…”

Section: Discussionmentioning

confidence: 58%

Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction

Belle

Motreff

Mangin

et al. 2016

Circ: Cardiovascular Interventions

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Background-Delayed stent implantation after restoration of normal epicardial flow by a minimalist immediate mechanical intervention aims to decrease the rate of distal embolization and impaired myocardial reperfusion after percutaneous coronary intervention. We sought to confirm whether a delayed stenting (DS) approach (24-48 hours) improves myocardial reperfusion, versus immediate stenting, in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods and Results-In the prospective, randomized, open-label minimalist immediate mechanical intervention (MIMI)trial, patients (n=140) with ST-segment-elevation myocardial infarction ≤12 hours were randomized to immediate stenting (n=73) or DS (n=67) after Thrombolysis In Myocardial Infarction 3 flow restoration by thrombus aspiration. Patients in the DS group underwent a second coronary arteriography for stent implantation a median of 36 hours (interquartile range 29-46) after randomization. The primary end point was microvascular obstruction (% left ventricular mass) on cardiac magnetic resonance imaging performed 5 days (interquartile range 4-6) after the first procedure. There was a nonsignificant trend toward lower microvascular obstruction in the immediate stenting group compared with DS group (1.88% versus 3.96%; P=0.051), which became significant after adjustment for the area at risk (P=0.049). Median infarct weight, left ventricular ejection fraction, and infarct size did not differ between groups. No difference in 6-month outcomes was apparent for the rate of major cardiovascular and cerebral events. Conclusions-The

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Section: Discussionmentioning

confidence: 58%

Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction

Belle

Motreff

Mangin

et al. 2016

Circ: Cardiovascular Interventions

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“…Superior clinical outcomes associated with DS may be driven by reduced wall damage and inflammatory response from balloon predilation [16], and fewer intimal dissections [17]. Balloon predilation before stenting is associated with higher risk of distal embolization and microvascular occlusion, which is associated with more reperfusion failure and lower probability of final TIMI 3 flow [3,18]. In our study, a relatively high incidence of procedural complications and lower TIMI III flow rate were observed in the conventional stent group versus the direct stent group, compatible with previous results.…”

Section: Discussionmentioning

confidence: 99%

Impact of direct stenting on clinical outcomes for small vessel coronary artery disease in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

Coşansu

Üreyen

Vatan

et al. 2019

pwki

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A b s t r a c t Introduction: Direct stenting (DS) is associated with improved markers of reperfusion during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). However, data evaluating its impact in small vessel coronary artery disease (CAD) are lacking.Aim: To compare DS and conventional stenting (CS) for small vessel CAD on clinical outcomes of patients with STEMI undergoing PPCI.Material and methods: A cohort of 616 STEMI patients treated with DS (202 patients) or CS (414 patients) in small vessel (≤ 2.75 mm) lesions was retrospectively analyzed. The primary endpoint was to compare the occurrence of major adverse cardiac events (MACE) between groups during 2-year follow-up. The secondary end points included in-hospital target lesion revascularization (TLR) and in-hospital death.Results: The primary end-point, MACEs, occurred in 9.2% in the DS group and 12.3% in the CS group (p > 0.05). The rates of TLR, myocardial infarction (MI) and target vessel revascularization (TVR) were not significantly different between groups (p > 0.05). The stent thrombosis (ST) rate was significantly lower in the DS group (1.0% vs. 4.2%, p = 0.04) at 2 years. However, DS was not found to be an independent predictor of ST in multivariate analysis. There were no significant differences in in-hospital rates of death and TLR. The DS compared to CS resulted in greater rates of postprocedural TIMI grade 3 flow, and lower risk of edge dissection. The procedure time, radiation exposure and contrast administration were found to be significantly lower in the DS group.Conclusions: In selected patients with STEMI undergoing PPCI for small vessel CAD, DS is not only safe and feasible but also reduces ST rates, contrast load, and procedural and radiation exposure time.Key words: direct stenting, ST-elevation myocardial infarction, primary percutaneous coronary intervention, conventional stenting, small vessel coronary artery. S u m m a r yThe impact of direct stenting on small vessel coronary culprit lesions in patients with ST-segment elevation myocardial infarction has not been investigated yet. The present study clearly emphasizes that direct stenting in selected lesions appears to be a safe and successful procedure, providing lower stent thrombosis and procedural complication rates. The procedural and radiation exposure time, and contrast load were also lower in the DS group.

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“…lesions of stable patients but this could not be the case of every thrombotic lesion during PPCI. Indeed, the available evidence suggests that direct stenting in STEMI might be associated with better clinical and procedural outcomes as compared to stenting with predilatation .…”

Section: Methodsmentioning

confidence: 99%

“…long lesion involving the ostial segment of the vessel) must be respected. Among the different BVS overlapping strategies described, the marker‐to‐marker or the scaffold‐to‐scaffold techniques are the recommended ones . Use of angiographic “stent enhancement” tool in two orthogonal projections can facilitate the marker‐to‐marker positioning.…”

Section: Methodsmentioning

confidence: 99%

A prospective evaluation of a standardized strategy for the use of a polymeric everolimus‐eluting bioresorbable scaffold in ST‐segment elevation myocardial infarction: Rationale and design of the BVS STEMI STRATEGY‐IT study

Ielasi

Varricchio²,

Campo

et al. 2016

Cathet Cardio Intervent

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

Cited by 30 publications

References 50 publications

Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction

Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction

Impact of direct stenting on clinical outcomes for small vessel coronary artery disease in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

A prospective evaluation of a standardized strategy for the use of a polymeric everolimus‐eluting bioresorbable scaffold in ST‐segment elevation myocardial infarction: Rationale and design of the BVS STEMI STRATEGY‐IT study

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