R H Mehta1, E R Bates. 1. Division of Cardiology, University of Michigan Hospital, Ann Arbor, MI 48109, USA.
Abstract
BACKGROUND: The purpose of this study was to provide an overview on stenting in acute myocardial infarction (MI). METHODS AND RESULTS: A search of MEDLINE and the scientific sessions abstracts in peer review journals through May 1998 was carried out to identify any publications on stenting in MI. The settings were retrospective and prospective case series on stenting in MI, nonrandomized and randomized trials comparing primary stenting and primary percutaneous transluminal coronary angioplasty (PTCA) in MI, and stenting in cardiogenic shock complicating MI. Reported outcomes included procedural success, reocclusion, restenosis, and target vessel revascularization rates; incidence of death, MI, recurrent ischemia, major bleeding, and vascular complications; and incidence of cerebrovascular accidents. Procedural success rates were better for stenting than primary PTCA, and postprocedural minimum luminal diameters were larger. This resulted in lower reocclusion and restenosis rates and a lesser need for target vessel revascularization with primary stenting. The incidence of death, MI, and recurrent ischemia was also reduced with primary stenting. Major bleeding and vascular complications were confined to patients receiving anticoagulation as opposed to antiplatelet agents after stenting. Finally, a strategy of bailout stenting for failed PTCA in MI appears to be inferior to a primary stenting strategy. CONCLUSIONS: Stenting in MI is an effective and safe reperfusion strategy with many advantages compared with primary PTCA.
BACKGROUND: The purpose of this study was to provide an overview on stenting in acute myocardial infarction (MI). METHODS AND RESULTS: A search of MEDLINE and the scientific sessions abstracts in peer review journals through May 1998 was carried out to identify any publications on stenting in MI. The settings were retrospective and prospective case series on stenting in MI, nonrandomized and randomized trials comparing primary stenting and primary percutaneous transluminal coronary angioplasty (PTCA) in MI, and stenting in cardiogenic shock complicating MI. Reported outcomes included procedural success, reocclusion, restenosis, and target vessel revascularization rates; incidence of death, MI, recurrent ischemia, major bleeding, and vascular complications; and incidence of cerebrovascular accidents. Procedural success rates were better for stenting than primary PTCA, and postprocedural minimum luminal diameters were larger. This resulted in lower reocclusion and restenosis rates and a lesser need for target vessel revascularization with primary stenting. The incidence of death, MI, and recurrent ischemia was also reduced with primary stenting. Major bleeding and vascular complications were confined to patients receiving anticoagulation as opposed to antiplatelet agents after stenting. Finally, a strategy of bailout stenting for failed PTCA in MI appears to be inferior to a primary stenting strategy. CONCLUSIONS: Stenting in MI is an effective and safe reperfusion strategy with many advantages compared with primary PTCA.