Main Article Content
Background: Primary percutaneous coronary intervention (PCI) with stent implantation has been the standard therapy in acute ST-segment elevation myocardial infarction (STEMI) patients. Compared with medical treatment alone, stent implanting can achieve larger lumen gain and helps to reduce the re-occlusion risk of the infarct-related artery.
Purpose: The aim of this study was to compare the effectiveness of stenting of single vessel intermediate culprit lesion stenosis to pharmacological treatment alone in acute STEMI patients.
Methods: This study was prospective comparative interventional case series. It included 60 patients admitted to coronary care unit of our University hospital with acute STEMI. All patients were subjected to detailed history taking, clinical examination, 12 leads ECG, echocardiography and cardiac catheterization and angiography (TIMI flow and corrected TIMI frame count (CTFC) was reported. Patients selected were those with intermediate culprit lesion (40-70%) single vessel stenosis.
Patients were divided into 2 groups:
Group A: 30 patients who underwent stenting of the culprit lesion in addition to standard pharmacological treatment.
Group B: 30 patients who received pharmacological treatment and no stenting (Glycoprotein II b/IIIa inhibitor in addition to the standard pharmacological treatment).
Patients were followed up for 12 months and major adverse cardiac events (MACE) were reported (death, myocardial infarction, coronary re-vascularization, stroke and hospitalization because of heart failure).
Results: 63.3% of group A patients reported complete ST segment resolution versus 30% of group B (P=0.034). TIMI Flow showed statistically significant difference in group A compared to group B regarding (P value=0.005) Group A reported slow fast blood flow (CTFC<60) in 1 patient (3.3%) while in group B it was reported in 5 patients (16%). There was a statistically significant difference between the 2 groups regarding CTFC (P value=0.029). At 12 months follow up, MACE were reported in one patient of group A versus 4 patients of group B (P value >0.05).
Conclusion: Stent implantation reported better immediate efficacy and safety results among acute STEMI patients with single vessel intermediate culprit lesion stenosis and favourable effects in reducing MACE.
2-Reddy K, Khaliq A, Henning RJ. Recent advances in the diagnosis and treatment 0f acute myocardial infarction. World J Cardiol. 2015;7(5):243-76.
Vavalle JP, van DS, Clare RM, et al. Renal failure in patients with ST-segment elevation acute myocardial infarcti0n treated with primary percutaneous coronary intervention: Predictors, clinical and angiographic features, and outcomes. Am Heart J. 2016;173:57-66.
Ganz W. The thrombolysis in myocardial infarction (TIMI) trial. N Engl J Med. 1985; 313:1018
Napodano M, Dariol G, Al Mamary AH, et al. Thrombus burden and myocardial damage during primary percutaneous coronary intervention. Am J Cardiol. 2014; 113:1449–1456.
Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: A quantitative method of assessing coronary artery flow. Circulation. 1996;93:879–888.
Alsheikh-Ali AA, Kitsios GD, Balk EM, et al. The vulnerable atherosclerotic plaque: Scope of the literature. Ann Intern Med. 2010;153:387–395.
Kelbaek H, Hofsten DE, Kober L, et al. Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (danami 3-defer): An open-label, randomised controlled trial. Lancet. 2016;387:2199–2206.
Legutko J, Dudek D, Chyrchel M, et al. Safety and effectiveness of pharmacologic versus mechanical stabilization of borderline coronary lesions in patients with acute coronary
Prati F, Uemura S, Souteyrand G, et al. OCT-based diagnosis and management of STEMI associated with intact fibrous cap. JACC Cardiovasc Imaging. 2013;6:283–287.
Watanabe J, Nakamura S, Sugiura T, et al. Early identification of impaired myocardial reperfusion with serial assessment of ST segments after percutaneous transluminal coronary angioplasty during acute myocardial infarction. Am J Cardiol. 2001; 88:956–959.