Vogel Rosanne F, Delewi Ronak, Wilschut Jeroen M, Lemmert Miguel E, Diletti Roberto, van Vliet Ria, van der Waarden Nancy W P L, Nuis Rutger-Jan, Paradies Valeria, Alexopoulos Dimitrios, Zijlstra Felix, Montalescot Gilles, Angiolillo Dominick J, Krucoff Mitchell W, Van Mieghem Nicolas M, Smits Pieter C, Vlachojannis Georgios J
Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
J Clin Med. 2023 Oct 20;12(20):6645. doi: 10.3390/jcm12206645.
Direct stenting (DS) compared with conventional stenting (CS) after balloon predilatation may reduce distal embolization during percutaneous coronary intervention (PCI), thereby improving tissue reperfusion. In contrast, DS may increase the risk of stent underexpansion and target lesion failure.
In this sub-study of the randomized COMPARE CRUSH trial (NCT03296540), we reviewed the efficacy of DS versus CS in a cohort of contemporary, pretreated ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. We compared DS versus CS, assessing (1) stent diameter in the culprit lesion, (2) thrombolysis in myocardial infarction (TIMI) flow in the infarct-related artery post-PCI and complete ST-segment resolution (STR) one-hour post-PCI, and (3) target lesion failure at one year. For proportional variables, propensity score weighting was applied to account for potential treatment selection bias.
This prespecified sub-study included 446 patients, of whom 189 (42%) were treated with DS. Stent diameters were comparable between groups (3.2 ± 0.5 vs. 3.2 ± 0.5 mm, = 0.17). Post-PCI TIMI 3 flow and complete STR post-PCI rates were similar between groups (DS 93% vs. CS 90%, adjusted OR 1.16 [95% CI, 0.56-2.39], = 0.69, and DS 72% vs. CS 58%, adjusted OR 1.29 [95% CI 0.77-2.16], = 0.34, respectively). Moreover, target lesion failure rates at one year were comparable (DS 2% vs. 1%, adjusted OR 2.93 [95% CI 0.52-16.49], = 0.22).
In this contemporary pretreated STEMI cohort, we found no difference in early myocardial reperfusion outcomes between DS and CS. Moreover, DS seemed comparable to CS in terms of stent diameter and one-year vessel patency.
与球囊预扩张后行传统支架置入术（CS）相比，直接支架置入术（DS）在经皮冠状动脉介入治疗（PCI）期间可能减少远端栓塞，从而改善组织再灌注。相比之下，DS可能增加支架扩张不全和靶病变失败的风险。
在随机对照的COMPARE CRUSH试验（NCT03296540）的这项子研究中，我们回顾了当代接受过预处理的ST段抬高型心肌梗死（STEMI）患者行直接PCI时DS与CS的疗效。我们比较了DS与CS，评估（1）罪犯病变处的支架直径，（2）PCI术后梗死相关动脉的心肌梗死溶栓（TIMI）血流以及PCI术后1小时的ST段完全回落（STR）情况，以及（3）1年时的靶病变失败情况。对于比例变量，应用倾向评分加权来解释潜在的治疗选择偏倚。
这项预先设定的子研究纳入了446例患者，其中189例（42%）接受了DS治疗。两组间支架直径相当（3.2±0.5 vs. 3.2±0.5 mm，P = 0.17）。两组间PCI术后TIMI 3级血流和PCI术后完全STR率相似（DS组为93% vs. CS组为90%，校正OR 1.16 [95% CI，0.56 - 2.39]，P = 0.69；DS组为72% vs. CS组为58%，校正OR 1.29 [95% CI 0.77 - 2.16]，P = 0.34）。此外，1年时的靶病变失败率相当（DS组为2% vs. CS组为1%，校正OR 2.93 [95% CI 0.52 - 16.49]，P = 0.22）。
在这个当代接受过预处理的STEMI队列中，我们发现DS与CS在早期心肌再灌注结果方面没有差异。此外，在支架直径和1年血管通畅率方面，DS似乎与CS相当。
