Comparative trial of stent-like balloon angioplasty versus coronary stenting for acute myocardial infarction

Primary PTCA has been shown to be superior to any thrombolytic regimen and offers higher reperfusion rates and better coronary flow grades. Its limita tions include recurrent ischemia (10%-15%), infarct-related artery reocclus ion (5%-10%), angiographic restenosis (35%-50%), and need to perform repeat PTCA or CABG at B-month follow-up (20%). Thus, the current role of coronar y stenting for acute myocardial infarction (AMI) is very promising. From De cember 1995 through January 1997, 335 patients underwent primary angioplast y during the first 12 hr from symptom onset at our institution. We performe d a retrospective study comparing the in-hospital and 6-month follow-up out come of 61 patients who underwent coronary stenting (stent group) against 6 1 patients with optimal (residual lesion stenosis < 30%) balloon-only prima ry angioplasty (stent-like group). Patients were routinely treated with asp irin, and ticlopidine was given only to the stent group. In-hospital major adverse cardiac events (MACE) rate was 11.5% without statistical difference s between the groups. Cardiac death rate was similar in both groups (4.9 vs . 6.6%; P = 1.0) and only two (3.3%) patients from the stent group and none from the PTCA group had nonfatal myocardial reinfarction. At 6-month follo w-up, the rate of recurrent angina was higher in the stent-like group (30.9 vs. 7.1%; P < 0.001). Multivariate analysis showed that only stenting of t he infarct-related artery was a borderline independent predictor for MACE ( OR = 0; 95% CI = 0-1; P = 0.057). Primary stenting for AMI reduces the rate of recurrent angina or symptoms and MACE at 6-month follow-up. (C) 2001 Wi ley-Liss, Inc.