Improved short-term outcomes of primary coronary stenting compared to primary balloon angioplasty in acute myocardial infarction at experienced centers: The PAMI study group experience

To study the additive benefits of routine stent implantation in patients un dergoing primary percutaneous transluminal coronary angioplasty (PTCA) at e xperienced centers, we compared the outcomes of the 982 patients undergoing PTCA for acute myocardial infarction (AMI) in the Primary Angioplasty in M yocardial Infarction-2 (PAMI-2) trial (only 1% of whom were stented) to the 312 patients in the PAMI Stent Pilot Trial (236 [76%] of whom were stented ). The inclusion and exclusion criteria, PTCA methodology, and definitions used were prespecified to be identical between the two trials. Compared to the primary PTCA approach in PAMI-2, the strategy of stenting all eligible lesions in the PAMI Stent Pilot Trial was associated with reduced rates of in-hospital death (0.6% vs 2.7%, P = 0.03) reinfarction (1.3% vs 4.6%, P = 0.008), recurrent ischemia (3.5% vs 11.6%, P < 0.0001), target vessel revas cularization (7.3% vs 11.4%, P = 0.04), and a shorter hospital stay (6.4 +/ - 4.4 vs 7.1 +/- 6.2 days, P = 0.01). By multiple logistic regression analy sis in 1,294 patients, stent implantation versus PTCA only was the stronges t predictor of freedom from the composite in-hospital end point of death, r einfarction, or target vessel revascularization (TVR) (8.3% vs 15.0%, multi variate odds ratio = 0.4, P < 0.0001). These data strongly suggest that des pite the excellent results achieved when primary PTCA is performed by exper ienced operators, the short-term outcomes of mechanical reperfusion can be further improved by a primary stent strategy.