INTRACORONARY STENTING IN 18 CASES OF ACUTE MYOCARDIAL-INFARCTION

Objective To evaluate the initial experience of intracoronary stenting in patients with acute myocardial infarction (AMI) in our hospital. M ethods Balloon-expansion stents were deployed in 18 patients (male: 15 , female 3, aged between 38-72 years old) with AMI after emergency PTC A. The major indications for intracoronary stenting in our present stu dy include: 1) acute reocclusion or high risk of reocclusion due to in timal dissection; 2) severe residual stenosis (greater than or equal t o 50% diameter stenosis) after repeat balloon dilation; and 3) obvious elastic recoil failed to response to repeat intracoronary nitroglycer in infusion. The dilating pressure for stent implantation was 12-18 at m with a dilating time of 10-30 sec. Patients were heparized during ca theter maneuvers and were medicated with Ticlopidine (250 mg, twice da ily) for 3 months and aspirin (250 mg, once daily) after stenting. Res ults 1) Coronary angiography (CAG) showed that all patients (n = 18) h ad a single-vessel total occlusion (left anterior decending 9, right c oronary artery 8, and left circuflex 1) before emergency PTCA and was successfully restored to TIMI 3 grade blood flow after intracoronary s tenting (13 with Nir stent, 1 with Jonson and Jonson stent, and 4 with Cordis stent). 2) Minor residual intracoronary thrombosis was present ed in 5 of 18 patients after PTCA, and it was totally disappeared afte r stenting; 3) One patient with inferior infarction developed III degr ee atrioventricular blockade (AVB) and temporary pacemaker was introdu ced. This patient died of cardiac tamponade 6 h after stenting due to right ventricular perforation by electrode. No cardiac death, recurren t angina and reinfarction occurred during the 4-16 months follow-up pe riod in the other 17 patients; 4) No angiographically restenois was fo und in all the 3 patients who had a secondary coronary angiography 4 w eeks after stenting. 5) Left ventricular ejection fraction (LVEF) dete rmined with Doppler echocardiography 4 weeks after stenting tended to be improved but failed to reach significant difference as compared to the basal LVEF (43. 27% +/- 8. 43% vs 40.58% +/- 7.23%, P > 0.05, n = 17) measured within 24 h after the onset of chest pain. Conclusions Th ese results suggest that intracoronary stenting is a highly effective strategy in prevention or treatment, of acute reocclusion after emerge ncy PTCA in AMI. Minor residual intracoronary thrombosis after balloon dilation was not a contraindication for stent implantation.