RANDOMIZED COMPARISON OF CORONARY STENTING WITH BALLOON ANGIOPLASTY IN SELECTED PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION

Background-Although the benefits of primary angioplasty in acute myoca rdial infarction have been demonstrated, several areas for improvement remain. Therefore, a prospective randomized trial comparing.primary s tenting with balloon angioplasty in patients with acute myocardial inf arction was conducted. Methods and Results-Patients with acute myocard ial infarction were randomly assigned to undergo either primary stenti ng (n=112) or balloon angioplasty (n=115). The clinical end points wer e death, recurrent infarction, subsequent bypass surgery, or repeat an gioplasty of the infarct-related vessel. The overall mortality rate at 6 months was 2%, Recurrent infarction occurred in 8 patients (7%) aft er balloon angioplasty and in 1 (1%) after stenting (P=0.036). Subsequ ent target-vessel revascularization was necessary in 19 (17%) and 4 (4 %) patients, respectively (P=0.0016), The cardiac event-free survival rate in the stent group was significantly higher than in the balloon a ngioplasty group (95% versus 80%; P=0.012). Conclusions-In selected pa tients with acute myocardial infarction, primary stenting can be appli ed safely and effectively, resulting in a lower incidence of recurrent infarction and a significant reduction in the need for subsequent tar get-vessel revascularization compared with balloon angioplasty.