A comparison of systematic stenting and conventional balloon angioplasty during primary percutaneous transluminal coronary angioplasty for acute myocardial infarction

OBJECTIVES In a multicenter, randomized trial, systematic stenting using th e Wiktor stent was compared to conventional balloon angioplasty with provis ional stenting for the treatment of acute myocardial infarction (AMI). BACKGROUND Primary angioplasty in AMT is limited by in-hospital recurrent i schemia and a high restenosis rate. METHODS A total of 211 patients with AMI <12 h from symptom onset, with an occluded native coronary artery, were randomly assigned to systematic stent ing (n 101) or balloon angioplasty (n = 110). The primary end point was the binary six-month restenosis rate determined by core laboratory quantitativ e angiographic analysis. RESULTS Angiographic success (Thrombolysis in Myocardial Infarction [TIMI] flow grade 3 and residual diameter stenosis <50%) was achieved in 86% of th e patients in the stent group and in 82.7% of those in the balloon angiopla sty group (p = 0.5). Compared with the 3% cross-over in the stent group, cr oss-over to stenting was required in 36.4% of patients in the balloon angio plasty group (p = 0.0001). Six-month binary restenosis (greater than or equ al to 50% residual stenosis) rates were 25.3% in the stent group and 39.6% in the balloon angioplasty group (p = 0.04). At six months, the event-free survival rates were 81.2% in the stent group and 72.7% in the balloon angio plasty group (p = 0.14), and the repeat revascularization rates were 16.8% and 26.4%, respectively (p = 0.1). At one year, the event-free survival rat es were 80.2% in the stent group and 71.8% in the balloon angioplasty group (p = 0.16), and the repeat revascularization rates were 17.8% and 28.2%, r espectively (p = 0.1). CONCLUSIONS In the setting of primary angioplasty for AMI, as compared with a strategy of conventional balloon angioplasty, systematic stenting using the Wiktor stent results in lower rates of angiographic restenosis. (J Am C oll Cardiol 2000;35:1729-36) (C) 2000 by the American College of Cardiology .