Primary intracoronary stenting in acute myocardial infarction: Long-term clinical and angiographic follow-up and risk factor analysis

Background Coronary stent placement may be an effective primary interventio n in acute myocardial infarction. Recently published or reported data indic ate that primary stenting may be superior to primary plain balloon angiopla sty in this setting. The aim of this study was to analyze the long-term cli nical and angiographic follow-up of patients treated with primary intracoro nary stenting and to identify the predictive factors of an adverse outcome. Methods The study population was composed of 519 consecutive patients with acute myocardial infarction (43 in cardiogenic shock) and attempted primary stent implantation. Adverse clinical events such as death, recurrent infar ction, and target vessel revascularization were recorded. Six-month follow- up angiography was performed in 78.2% of the eligible patients, and coronar y dimensions were assessed with an automated quantitative system. Results Procedural success was achieved in 500 patients (96.3%). The incide nce of reocclusion was 3.2%. Thirty-day mortality rate was 5.4% (2.5% in pa tients without shock); adverse clinical events were encountered in 10.4% of the patients. Independent risk factors for an adverse outcome were longer time to treatment, Killip class, reduced left ventricular function, overlap ping stents, and residual dissection. The incidence of angiographic resteno sis was 30.6%. One-year survival rate was 89.0%; 86.5% of the patients did not have a myocardial infarction and 71.7% did not have any major adverse e vent. Conclusions Primary intracoronary stenting in patients with acute myocardia l infarction is associated with a favorable early and long-term outcome. Th is is the result of low reocclusion and restenosis rates achieved by stenti ng.