RETROSPECTIVE COMPARATIVE-STUDY OF PRIMARY INTRACORONARY STENTING VERSUS BALLOON ANGIOPLASTY FOR ACUTE MYOCARDIAL-INFARCTION

Balloon angioplasty has been shown to be an effective therapy for the treatment of acute myocardial infarction but is associated with a high restenosis rate, substantial early recoil, persistent thrombus and ne ed for intracoronary thrombolysis, and a high rate of reclosure. Becau se many of the limitations of balloon angioplasty in the noninfarction setting are addressed by intracoronary stenting, we examined the resu lts of primary stenting of 18 consecutive patients treated for acute m yocardial infarction, and compared the results to those achieved with primary balloon angioplasty in 18 prior cases. Despite the presence of thrombus prior to angioplasty in 13 of the stented patients, no intra coronary thrombolytic therapy was required. Mean percent stenosis usin g quantitative coronary angiography was 17.7+/-10.2% after primary ste nting compared with 43.7+/-20.3% after primary balloon angioplasty (P <.001). One stent patient who had all anticoagulant and antiplatelet t herapy withdrawn early suffered subacute thrombosis. Patients were fol lowed up to 3 yr. Complications were similar in the two groups. We con clude that primary stenting for acute myocardial infarction results in superior angiographic appearance as well as resolution of thrombus wi thout the need for routine thrombolysis, and is associated with a low complication rate and excellent short-termclinical patency. (C) 1997 W iley-Liss, Inc.