Nonrandomized comparison between stent deployment and percutaneous transluminal coronary angioplasty in acute myocardial infarction

Background Compared with angioplasty, elective stent implantation has impro ved short-term and long-term outcome with a decrease in abrupt closure and a reduced 6-month restenosis rate. Although primary angioplasty during acut e myocardial infarction has improved outcome, recurrent ischemic events and restenosis are still a problem. Methods outcomes for 166 consecutively treated patients who underwent stent insertion procedures within 24 hours after the onset of acute myocardial i nfarction were compared with those for a similar group of patients (n = 212 ) who underwent consecutive balloon angioplasty procedures at one tertiary care institution. The objective of this study was to examine in-hospital an d late clinical outcomes for the 2 groups. Results The procedural success rate for stenting in acute myocardial infarc tion was 100%; that for angioplasty was 98%. Mortality rates during hospita lization were similar for the stent group and the angioplasty group (4.0% v s 2.0%). The rate of in-hospital acute reocclusion necessitating urgent per cutaneous reintervention was significantly lower for the stent group (0% vs 30%, P = .02). Six months after the procedure, the stent group had a signi ficantly lower need for revascularization of the infarct-related artery (8% vs 20%, P = .001) and a significantly tower incidence of combined serious clinical events (death, acute occlusion, emergency bypass, target vessel re vascularization, and nonfatal myocardial infarction; 12%; vs 30%, P = .0000 3). Conclusion Compared with balloon angioplasty, stent deployment in the setti ng of acute myocardial infarction was associated with significantly lower f requency of in-hospital acute occlusion and significantly less need for tar get-vessel revascularization 6 months after myocardial infarction.