Impact of direct stenting on clinical outcomes for small vessel coronary artery disease in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

Kahraman Cosansu; Cagin Mustafa Ureyen; Mehmet Bulent Vatan; Mustafa Tarik Agac; Harun Kilic; Ramazan Akdemir

doi:10.5114/aic.2019.90214

Impact of direct stenting on clinical outcomes for small vessel coronary artery disease in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

Postepy Kardiol Interwencyjnej. 2019;15(4):404-411. doi: 10.5114/aic.2019.90214. Epub 2019 Dec 8.

Authors

Kahraman Cosansu¹, Cagin Mustafa Ureyen², Mehmet Bulent Vatan¹, Mustafa Tarik Agac¹, Harun Kilic¹, Ramazan Akdemir¹

Affiliations

¹ Department of Cardiology, Sakarya University Education and Research Hospital, Sakarya, Turkey.
² Department of Cardiology, Antalya Education and Research Hospital, Antalya, Turkey.

Abstract

Introduction: Direct stenting (DS) is associated with improved markers of reperfusion during primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). However, data evaluating its impact in small vessel coronary artery disease (CAD) are lacking.

Aim: To compare DS and conventional stenting (CS) for small vessel CAD on clinical outcomes of patients with STEMI undergoing PPCI.

Material and methods: A cohort of 616 STEMI patients treated with DS (202 patients) or CS (414 patients) in small vessel (≤ 2.75 mm) lesions was retrospectively analyzed. The primary endpoint was to compare the occurrence of major adverse cardiac events (MACE) between groups during 2-year follow-up. The secondary end points included in-hospital target lesion revascularization (TLR) and in-hospital death.

Results: The primary end-point, MACEs, occurred in 9.2% in the DS group and 12.3% in the CS group (p > 0.05). The rates of TLR, myocardial infarction (MI) and target vessel revascularization (TVR) were not significantly different between groups (p > 0.05). The stent thrombosis (ST) rate was significantly lower in the DS group (1.0% vs. 4.2%, p = 0.04) at 2 years. However, DS was not found to be an independent predictor of ST in multivariate analysis. There were no significant differences in in-hospital rates of death and TLR. The DS compared to CS resulted in greater rates of postprocedural TIMI grade 3 flow, and lower risk of edge dissection. The procedure time, radiation exposure and contrast administration were found to be significantly lower in the DS group.

Conclusions: In selected patients with STEMI undergoing PPCI for small vessel CAD, DS is not only safe and feasible but also reduces ST rates, contrast load, and procedural and radiation exposure time.

Keywords: ST-elevation myocardial infarction; conventional stenting; direct stenting; primary percutaneous coronary intervention; small vessel coronary artery.