PROSPECTIVE, MULTICENTER STUDY OF THE SAFETY AND FEASIBILITY OF PRIMARY STENTING IN ACUTE MYOCARDIAL-INFARCTION - IN-HOSPITAL AND 30-DAY RESULTS OF THE PAMI STENT PILOT TRIAL

Citation
Gw. Stone et al., PROSPECTIVE, MULTICENTER STUDY OF THE SAFETY AND FEASIBILITY OF PRIMARY STENTING IN ACUTE MYOCARDIAL-INFARCTION - IN-HOSPITAL AND 30-DAY RESULTS OF THE PAMI STENT PILOT TRIAL, Journal of the American College of Cardiology, 31(1), 1998, pp. 23-30
Citations number
52
Categorie Soggetti
Cardiac & Cardiovascular System
ISSN journal
07351097
Volume
31
Issue
1
Year of publication
1998
Pages
23 - 30
Database
ISI
SICI code
0735-1097(1998)31:1<23:PMSOTS>2.0.ZU;2-C
Abstract
Objectives. The goals of this study were to examine the safety and fea sibility of a routine (primary) stent strategy in acute myocardial inf arction (AR?II).Background. Limitations of reperfusion by primary perc utaneous transluminal coronary angioplasty (PTCA) in AMI include in-ho spital recurrent ischemia or reinfarction in 10% to 15% of patients, r estenosis in 37% to 49% and late infarct-related artery reocclusion in 9% to 14%. By lowering the residual stenosis and sealing dissection p lanes created by PTCA, primary stenting may further improve short- and long-term outcomes after mechanical reperfusion. Methods. Three hundr ed twelve consecutive patients treated with primary PTCA for AMI at ni ne international centers were prospectively enrolled. After PTCA, sten ting was attempted in all eligible lesions (vessel size 3.0 to 4.0 mm; lesion length less than or equal to 2 stents; and the absence of gian t thrombus burden after PTCA, major side branch jeopardy or excessive proximal tortuosity or calcification). Patients with stents were treat ed with aspirin, ticlopidine and a 60-h tapering heparin regimen. Resu lts. Stenting,vas attempted in 240 (77%) of 312 patients, successfully in 236 (98%), with Thrombolysis in Myocardial Infarction grade 3 flow restored in 230 patients (96%). Patients with stents had low rates of in-hospital death (0.8%), reinfarction (1.7%), recurrent ischemia (3. 8%) and predischarge target vessel revascularization for ischemia (1.3 %). At 30-day follow up, no additional deaths or reinfarctions occurre d among patients with stents, and target vessel revascularization was required in only one additional patient (0.4%). Conclusions. Primary s tenting is safe and feasible in the majority of patients with AMI and results in excellent short term outcomes. (C) 1998 by the American Col lege of Cardiology.