A prospective evaluation of angiography-guided coronary stent implantationwith high versus very high balloon inflation pressure

Background High inflation pressure (HP) after coronary tent deployment has become a standard approach because ii has been associated with a decreased subacute stent thrombosis (SAT) rate. However, the impact of HP on long-ter m outcomes is still unclear. We compared the long-term results of a strateg y of increasing HP (greater than or equal to 12 atm) until the achievement of angiographic success (<20% residual stenosis) with a prespecified very h igh inflation pressure (VHP) strategy of 20 atm without intermediate inflat ions. Methods and Results We conducted a parallel-group, nonrandomized study to e valuate the short- and long-term results in 136 consecutive eligible patien ts who underwent successful single Palmaz-Schatz stent implantation in vess els <greater than or equal to>3 mm. Major adverse cardiac events (MACE), th at is, death, myocardial infarction, and target lesion revascularization (T LR), were monitored for a minimum of 6 months. No significant differences w ere observed between the two strategies in terms of final minimal lumen dia meter (HP, 3.0 +/- 0.5 vs VHP, 3.1 +/- 0.5 mm) and acute gain (HP, 2.1 +/- 0.7 vs VHP, 2.2 +/- 0.6). The overall rate of subacute stent thrombosis was 0.7%. During a 405 +/- 148-day follow-vp, 21 (28.8%) patients in the VHP g roup and 6 (9.5%) in the HP group (P = .005) had MACE, with a TLR rate of 2 7.4% versus 7.9% (P = .009), respectively. By multivariate analysis, the us e of VHP increased the odds of long-term MACE by a factor of 3.48 (P = .009 ). Among patients undergoing TLR, those treated with VHP had a greater lume n loss (HP, 1.83 +/- 0.57 vs VHP, 2.15 +/- 0.36 mm, P = .02) and a more fre quent pattern of diffuse restenosis (71 % vs 16%, P = .06). Conclusions In our study, the two strategies had similar acute and short-te rm results, but VH P was associated with a poorer long-term outcome. These data provide a rationale for a less aggressive strategy for stent deploymen t by optimizing rather than attempting to maximize inflation pressure and s tent expansion.