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
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
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.