BACKGROUND: In the practice of percutaneous coronary intervention, post-dilation often is performed after stent deployment to improve stent expansion. However, aggressive mechanical expansion is a risk factor of distal embolization and microvascular injury, especially for patients with acute myocardial infarction (AMI). Few studies have investigated the effects of post-dilation on medium-term clinical outcomes. METHODS AND RESULTS: Patients enrolled in the multicenter NHLBI Dynamic Registry between 2001 and 2006 were evaluated. Patients who were treated with ≥ 1 stent were studied. Patients with cardiogenic shock or history of coronary artery bypass graft surgery were excluded. Patients were followed up to 1 year. Because of the significant statistical interaction (P = .02) between post-dilation and AMI status on the hazard of death/myocardial infarction (MI), post-dilation effects were estimated separately for patients who did and did not present with an AMI. Among the 1,358 patients who presented with an AMI, post-dilation was associated with a significantly higher risk of death/MI (hazard ratio [HR] = 1.78, 95% CI 1.12-2.83, P = .01), not associated with the risk of repeat revascularization (HR = 1.15, 95% CI 0.81-1.62, P = .43). Among the 3,001 patients who did not present with AMI, post-dilation was not associated with risks of death/MI (HR = 1.08, 95% CI 0.77-1.50, P = .67) or repeat revascularization (HR = 1.17, 95% CI 0.93-1.47, P = .19). Similar effects were observed for the restricted analysis with additional adjustment for lesion characteristics among the 1,039 AMI patients and 2,179 non-AMI patients with a single lesion treated. CONCLUSIONS: Stent post-dilation is associated with an increased risk of death/MI in AMI patients but not in non-AMI patients. Further investigation is warranted.
BACKGROUND: In the practice of percutaneous coronary intervention, post-dilation often is performed after stent deployment to improve stent expansion. However, aggressive mechanical expansion is a risk factor of distal embolization and microvascular injury, especially for patients with acute myocardial infarction (AMI). Few studies have investigated the effects of post-dilation on medium-term clinical outcomes. METHODS AND RESULTS:Patients enrolled in the multicenter NHLBI Dynamic Registry between 2001 and 2006 were evaluated. Patients who were treated with ≥ 1 stent were studied. Patients with cardiogenic shock or history of coronary artery bypass graft surgery were excluded. Patients were followed up to 1 year. Because of the significant statistical interaction (P = .02) between post-dilation and AMI status on the hazard of death/myocardial infarction (MI), post-dilation effects were estimated separately for patients who did and did not present with an AMI. Among the 1,358 patients who presented with an AMI, post-dilation was associated with a significantly higher risk of death/MI (hazard ratio [HR] = 1.78, 95% CI 1.12-2.83, P = .01), not associated with the risk of repeat revascularization (HR = 1.15, 95% CI 0.81-1.62, P = .43). Among the 3,001 patients who did not present with AMI, post-dilation was not associated with risks of death/MI (HR = 1.08, 95% CI 0.77-1.50, P = .67) or repeat revascularization (HR = 1.17, 95% CI 0.93-1.47, P = .19). Similar effects were observed for the restricted analysis with additional adjustment for lesion characteristics among the 1,039 AMI patients and 2,179 non-AMI patients with a single lesion treated. CONCLUSIONS: Stent post-dilation is associated with an increased risk of death/MI in AMI patients but not in non-AMI patients. Further investigation is warranted.
Authors: P J Fitzgerald; A Oshima; M Hayase; J A Metz; S R Bailey; D S Baim; M W Cleman; E Deutsch; D J Diver; M B Leon; J W Moses; S N Oesterle; P A Overlie; C J Pepine; R D Safian; J Shani; C A Simonton; R W Smalling; P S Teirstein; J P Zidar; A C Yeung; R E Kuntz; P G Yock Journal: Circulation Date: 2000-08-01 Impact factor: 29.690
Authors: Kenichi Fujii; Stéphane G Carlier; Gary S Mintz; Yi-ming Yang; Issam Moussa; Giora Weisz; George Dangas; Roxana Mehran; Alexandra J Lansky; Edward M Kreps; Michael Collins; Gregg W Stone; Jeffrey W Moses; Martin B Leon Journal: J Am Coll Cardiol Date: 2005-04-05 Impact factor: 24.094
Authors: Gregg W Stone; Michael A Peterson; Alexandra J Lansky; George Dangas; Roxana Mehran; Martin B Leon Journal: J Am Coll Cardiol Date: 2002-02-20 Impact factor: 24.094
Authors: Giuseppe De Luca; Arnoud W J van 't Hof; Jan Paul Ottervanger; Jan C A Hoorntje; A T Marcel Gosselink; Jan-Henk E Dambrink; Felix Zijlstra; Menko-Jan de Boer; Harry Suryapranata Journal: Am Heart J Date: 2005-09 Impact factor: 4.749
Authors: Bruce R Brodie; Christopher Cooper; Michael Jones; Peter Fitzgerald; Frank Cummins Journal: Catheter Cardiovasc Interv Date: 2003-06 Impact factor: 2.692
Authors: Oscar C Marroquin; Faith Selzer; Suresh R Mulukutla; David O Williams; Helen A Vlachos; Robert L Wilensky; Jean-François Tanguay; Elizabeth M Holper; J Dawn Abbott; Joon S Lee; Conrad Smith; William D Anderson; Sheryl F Kelsey; Kevin E Kip Journal: N Engl J Med Date: 2008-01-24 Impact factor: 91.245
Authors: Zhi-Jiang Zhang; Oscar C Marroquin; Joel L Weissfeld; Roslyn A Stone; Suresh R Mulukutla; David O Williams; Faith Selzer; Kevin E Kip Journal: Eur J Cardiovasc Prev Rehabil Date: 2009-08
Authors: Peshala T Gamage; Pengfei Dong; Juhwan Lee; Yazan Gharaibeh; Vladislav N Zimin; Luis A P Dallan; Hiram G Bezerra; David L Wilson; Linxia Gu Journal: Comput Biol Med Date: 2021-10-21 Impact factor: 4.589
Authors: Alexander Tsoukas; Sasha Bernatsky; Lawrence Joseph; David L Buckeridge; Patrick Bélisle; Christian A Pineau Journal: Int J Rheumatol Date: 2017-06-21
Authors: Jabir A; Anoop Mathew; Sunitha Viswanathan; Ashraf S M; Placid Sebastian; Prasannakumar C K; George Koshy A; Sunil Pisharody; Rony Mathew; L Jeyasheelan Journal: Indian Heart J Date: 2017-05-31