Is routine stenting for acute myocardial infarction superior to balloon angioplasty? A randomised comparison in a large cohort of unselected patients

Abstract

Objective: To evaluate the impact of routine stenting, compared with balloon angioplasty, in unselected patients presenting with ST segment elevation myocardial infarction (STEMI). Design: Randomised trial. Setting: Tertiary referral centre. Participants: All patients presenting with STEMI randomly assigned to stenting or balloon angioplasty. No exclusion criteria were applied. Main outcome measure: The primary end point was combined death or reinfarction at one year's follow up.Results: 1683 consecutive patients with STEMI were randomly assigned before angiography to stenting (n = 849) or balloon angioplasty (n = 834). A total of 785 patients (92.5%) in the stent group and 763 patients (91.5%) in the balloon group actually underwent primary angioplasty. The groups were comparable in terms of postprocedural TIMI (thrombolysis in myocardial infarction) flow, myocardial blush grade, and distal embolisation. No difference was observed in clinical outcome at both intention to treat (14% v 12.5%, not significant) and actual treatment analyses (12.4% v 11.3%, not significant). Conclusions: Compared with balloon angioplasty, routine stenting does not seem to reduce death and reinfarction in a large cohort of unselected patients with STEMI.

Circumflex artery-related acute myocardial infarction: limited ECG abnormalities but poor outcome

“…5 In brief, 1683 patients with more than 30 minutes of chest pain together with ST-segment elevation of at least 1 mm in two consecutive leads were included. Patients whose symptoms began between 6 to 24 hours before admission or who lacked ST-segment elevation were also included if they had persistent chest pain or signs of ischaemia or had regional wall motion abnormalities on echocardiography.…”

“…Quantitative coronary angiography was performed before and after PCI as previously described. 5 Successful angioplasty was defined as TIMI 3 flow of the infarct-related vessel in combination with a <50% residual stenosis (core lab analysis).…”

The Influence of Multifocal Atherosclerosis on Long-Term Outcomes After Endovascular Revascularization in Myocardial Infarction

“…Представленные результаты анализа ангиографи-ческих показателей свидетельствуют о том, что МФА может являться фактором неблагоприятного про-гноза не только в силу взаимосвязи с тяжестью пора-жения коронарного русла, но, в основном, как неза-висимый предиктор развития неблагоприятных кар-диоваскулярных событий у больных ИБС, что согласуется с данными литературы [3][4][5][6]8]. Возмож-ным механизмом, посредством которого реализу-ется осложненное течение заболевания при МФА, может быть его ассоциация с комплексом факторов сердечно-сосудистого риска, ассоциированными заболеваниями и более агрессивным течением ате-росклероза.…”

“…При длительном наблюдении установлено, что пациенты, перенесшие ИМ, подвергаются сущест-венному риску смерти и развития рецидивирующих эпизодов ишемии. Данные регис тра OASIS показы-вают, что частота указанных событий наиболее высока на протяжении первых трех месяцев наблю-дения, однако риск возникновения смерти, ИМ или инсульта остается высоким (более 7% в год в тече-ние, по меньшей мере, двух лет) [5]. Кроме того, по данным регистра GRACE, частота внутригоспи-тальных инсультов (2,1%) при ИМ выше, чем при нестабильной стенокардии (1,2%; р<0,001).…”

Impact of Routine Stenting on Clinical Outcome in Diabetic Patients Undergoing Primary Angioplasty for ST-Segment Elevation Myocardial Infarction

“…October 2001, all patients with STEMI, who were admitted within the first 6 h or between 6 and 24 h if they had persistent symptoms with evidence of ongoing ischemia, were randomized to stenting or balloon angioplasty before the initial angiogram (12). Informed consent was obtained from each patient (or from their relatives in case of patient's inability) before the angiogram.…”