COMPARISON OF PRIMARY CORONARY STENTING TO PRIMARY BALLOON ANGIOPLASTY WITH STENT BAILOUT FOR THE TREATMENT OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION

This study compares the immediate and long-term outcomes of a primary coronary stenting strategy with primary balloon angioplasty with stent bailout in the treatment of patients with acute myocardial infarction (AMI). One hundred forty-seven consecutive patients who underwent pri mary balloon angioplasty with stent bailout (n = 94) or primary stenti ng (n = 53) for AMI were clinically followed for 8.1 +/- 5.7 and 8.5 /- 4.5 months, respectively. Immediate results, as well as in-hospital and long-term ischemic events (death, reinfarction, and repeat revasc ularization) were compared between both groups. Angiographic success w as 91.5% in the balloon angioplasty group and 94% in the stent group. In-hospital and late follow-up combined ischemic events were 22 of 94 (23%) versus 0 of 53 (0%); p <0.001 and 33 of 78 (42%) versus 13 of 53 (25%), p = 0.04 for the balloon angioplasty and stent groups, respect ively. At 6 months, the cumulative probability of repeat target lesion revascularization was higher in the balloon angioplasty group (47% vs 18%, p = 0.0006) as was the probability of lan target revascularizati on (36% vs 18% p = 04046); the cumulative event-free survival after 6 months was significantly lower in the balloon angioplasty group (44% v s 80%, p = 0.0001). This study demonstrates that a primary stent place ment strategy in patients with AMI is safe, feasible, and superior to primary balloon angioplasty with stent bailout. Primary stenting resul ts in a larger postprocedural minimal luminal diameter, a lower early and lan recurrent ischemic event rate, and a lower incidence of target lesion revascularization at follow-up. (C) 1998 by Excerpta Medico, I nc.