Stenting versus Pharmacological Therapy in Treatment of Single Vessel Intermediate Culprit Lesion Stenosis in Acute St-Segment Elevation Myocardial Infarction
Hazem K. Shalaby *
Cardiology Department, Faculty of Medicine, Tanta University, Egypt.
Ayman Mohammed El Saied
Cardiology Department, Faculty of Medicine, Tanta University, Egypt.
Hanan Kasem
Cardiology Department, Faculty of Medicine, Tanta University, Egypt.
Mai Salama
Cardiology Department, Faculty of Medicine, Tanta University, Egypt.
Seham Fahmy Badr
Cardiology Department, Faculty of Medicine, Tanta University, Egypt.
*Author to whom correspondence should be addressed.
Abstract
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.
Keywords: STEMI, intermediate stenosis, culprit lesion, primary PCI, MACE.