Primary coronary infarct artery stenting in acute myocardial infarction

Completed and ongoing randomized trials have provided results that favor pr imary infarct-related artery (IRA) stenting as opposed to primary percutane ous transluminal coronary angioplasty, but the applicability of the trial r esults to all patients with acute myocardial infarction (AMI) has not yet b een investigated. This study sought to determine the applicability of an un conditional IRA stenting strategy in nonselected patients with AMI. After s uccessful mechanical recanalization of the IRA, all patients with AMI and a reference diameter greater than or equal to 2.5 mm were considered eligibl e for primary IRA stenting without any restriction regarding age or clinica l status on presentation. The primary end point of the study was a composit e end point defined as death, reinfarction, or repeat target lesion revascu larization. Primary IRA stenting was successfully performed in 161 of 190 c onsecutive patients with AMI (85%), and of 162 (99%) considered suitable fo r stenting. Patients with nonstented IRA had a reference IRA diameter small er than patients with a stent (2.71 +/- 0.48 vs 3.20 +/- 0.41 mm, p <0.001) . Overall, the 6-month mortality was 5%, Mortality was 2% for patients with out, and 32% for patients with cardiogenic shock. The incidences of reinfar ction and of repeat target lesion revascularization were 1% and 12%, respec tively. The 6-month angiographic follow-vp showed an IRA patency rate of 94 % and a restenosis rate of 26%. The results of this study strengthen the hy pothesis that unconditional primary IRA stenting is highly feasible, and ma y actually improve the outcome of patients with AMI. (C) 1999 by Excerpta M edico, Inc.