Kalayci A, Oduncu V, Karabay C Y, Erkol A, Tanalp A C, Tanboga I H, Candan O, Gecmen C, Izgi I A, Kirma C
Kosuyolu Heart and Research Hospital, Kosuyolu, Turkey.
Herz. 2018 Aug;43(5):447-454. doi: 10.1007/s00059-017-4581-2. Epub 2017 Jun 14.
We compared direct stenting (DS) with conventional stenting (CS) - i.e., stenting after predilation - during primary percutaneous coronary intervention (P-PCI) in terms of procedural results and long-term mortality in patients with ST-elevated myocardial infarction (STEMI).
We retrospectively analyzed 2306 patients (mean age 59 years, 22% female) who underwent P‑PCI within 12 h of symptom onset. Patients were then followed up prospectively for clinical events. Patients were divided into a DS group (n = 597) and a CS group (n = 1709). The CS group was further divided into a CS-1 group (baseline thrombolysis in myocardial infarction [TIMI] flow grade ≥ 1) and a CS-2 group (baseline TIMI flow grade 0). Main outcome measures were postprocedural myocardial reperfusion and all-cause mortality in long-term follow-up.
Patients in the DS group had a higher percentage of final TIMI-3 flow, myocardial blush grade 3 and complete ST-segment resolution, better left ventricular ejection fraction, and a lower incidence of distal embolization compared with CS patients. In-hospital (1.5 vs. 4.6%, respectively, p = 0.001) and long-term all-cause mortality (8.8 vs. 17.0%, respectively, p < 0.001) were significantly lower in the DS group than in the CS group. Kaplan-Meier survival analysis showed similar survival rates in the DS and CS-1 groups (log-rank p = 0.40), but significantly worse survival in the CS-2 group than in the other groups (log-rank p < 0.001). After adjusting for risk factors, DS was not found to be a predictor of long-term mortality.
DS in P‑PCI was associated with better postprocedural angiographic results and long-term survival. However, the DS group had similar in-hospital and long-term mortality to matched patients in the CS group.
我们比较了直接支架置入术（DS）与传统支架置入术（CS）——即预扩张后支架置入术——在ST段抬高型心肌梗死（STEMI）患者的直接经皮冠状动脉介入治疗（P-PCI）中的手术结果和长期死亡率。
我们回顾性分析了2306例症状发作后12小时内接受P-PCI的患者（平均年龄59岁，22%为女性）。然后对患者进行前瞻性临床事件随访。患者被分为DS组（n = 597）和CS组（n = 1709）。CS组进一步分为CS-1组（基线心肌梗死溶栓[TIMI]血流分级≥1）和CS-2组（基线TIMI血流分级0）。主要结局指标为术后心肌再灌注和长期随访中的全因死亡率。
与CS患者相比，DS组患者最终TIMI-3血流、心肌 blush分级3和ST段完全恢复的比例更高，左心室射血分数更好，远端栓塞发生率更低。DS组的住院（分别为1.5%和4.6%，p = 0.001）和长期全因死亡率（分别为8.8%和17.0%，p < 0.001）显著低于CS组。Kaplan-Meier生存分析显示DS组和CS-1组的生存率相似（对数秩p = 0.40），但CS-2组的生存率明显低于其他组（对数秩p < 0.001）。在调整危险因素后，未发现DS是长期死亡率的预测因素。
P-PCI中的DS与更好的术后血管造影结果和长期生存相关。然而，DS组的住院和长期死亡率与CS组中匹配患者相似。
