1
|
Aldujeli A, Haq A, Tsai TY, Grabauskyte I, Tatarunas V, Briedis K, Rana S, Unikas R, Hamadeh A, Serruys PW, Brilakis ES. The impact of primary percutaneous coronary intervention strategies during ST-elevation myocardial infarction on the prevalence of coronary microvascular dysfunction. Sci Rep 2023; 13:20094. [PMID: 37973856 PMCID: PMC10654664 DOI: 10.1038/s41598-023-47343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/12/2023] [Indexed: 11/19/2023] Open
Abstract
Coronary microvascular dysfunction (CMD) is a common complication of ST-segment elevation myocardial infarction (STEMI) and can lead to adverse cardiovascular events. This is a non-randomized, observational, prospective study of STEMI patients with multivessel disease who underwent primary PCI, grouped based on whether they underwent balloon pre-dilatation stenting or direct stenting of the culprit lesion. Coronary physiology measurements were performed 3 months post-PCI including coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) measurements at the culprit vessel. The primary endpoint was the prevalence of CMD at 3 months, defined as IMR ≥ 25 or CFR < 2.0 with a normal fractional flow reserve. Secondary endpoints included major adverse cardiovascular events (MACE) at 12 months. Two hundred ten patients were enrolled; most were men, 125 (59.5%), with a median age of 65 years. One hundred twelve (53.2%) underwent balloon pre-dilatation before stenting, and 98 (46.7%) underwent direct stenting. The prevalence of CMD at 3 months was lower in the direct stenting group than in the balloon pre-dilatation stenting group (12.24% vs. 40.18%; p < 0.001). Aspiration thrombectomy and administration of intracoronary glycoprotein IIb/IIIa inhibitors were associated with lower odds of CMD (OR = 0.175, p = 0.001 and OR = 0.113, p = 0.001, respectively). Notably, MACE in patients who underwent direct stenting was lower than in those who underwent balloon pre-dilatation before stenting (14.29% vs. 26.79%; p = 0.040). In STEMI patients with multivessel disease, direct stenting of the culprit lesion, aspiration thrombectomy and administration of intracoronary glycoprotein IIb/IIIa inhibitors were associated with a lower prevalence of CMD at 3 months and lower incidence of MACE at 12 months compared with balloon pre-dilatation stenting.This trial is registered at https://ichgcp.net/clinical-trials-registry/NCT05406297 .
Collapse
Affiliation(s)
- Ali Aldujeli
- Lithuanian University of Health Sciences, Sukileliu pr. 15, 50161, Kaunas, Lithuania.
| | - Ayman Haq
- Abbott Northwestern Hospital/Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | | | - Ingrida Grabauskyte
- Lithuanian University of Health Sciences, Sukileliu pr. 15, 50161, Kaunas, Lithuania
| | - Vacis Tatarunas
- Lithuanian University of Health Sciences, Sukileliu pr. 15, 50161, Kaunas, Lithuania
| | - Kasparas Briedis
- Lithuanian University of Health Sciences, Sukileliu pr. 15, 50161, Kaunas, Lithuania
| | - Sumit Rana
- Thorndale Medical Clinic, Dublin, Ireland
| | - Ramunas Unikas
- Lithuanian University of Health Sciences, Sukileliu pr. 15, 50161, Kaunas, Lithuania
| | - Anas Hamadeh
- Heart and Vascular Specialists of North Texas, Arlington, TX, USA
| | | | - Emmanouil S Brilakis
- Abbott Northwestern Hospital/Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| |
Collapse
|
2
|
Vogel RF, Delewi R, Wilschut JM, Lemmert ME, Diletti R, van Vliet R, van der Waarden NWPL, Nuis RJ, Paradies V, Alexopoulos D, Zijlstra F, Montalescot G, Angiolillo DJ, Krucoff MW, Van Mieghem NM, Smits PC, Vlachojannis GJ. Direct Stenting versus Conventional Stenting in Patients with ST-Segment Elevation Myocardial Infarction-A COMPARE CRUSH Sub-Study. J Clin Med 2023; 12:6645. [PMID: 37892785 PMCID: PMC10607208 DOI: 10.3390/jcm12206645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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, p = 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], p = 0.69, and DS 72% vs. CS 58%, adjusted OR 1.29 [95% CI 0.77-2.16], p = 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], p = 0.22). CONCLUSION 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.
Collapse
Affiliation(s)
- Rosanne F. Vogel
- 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
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Jeroen M. Wilschut
- Department of Cardiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Miguel E. Lemmert
- Department of Cardiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Department of Cardiology, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Roberto Diletti
- Department of Cardiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Ria van Vliet
- Department of Cardiology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | | | - Rutger-Jan Nuis
- Department of Cardiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Valeria Paradies
- Department of Cardiology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | | | - Felix Zijlstra
- Department of Cardiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Gilles Montalescot
- ACTION Group, Groupe Hospitalier Pitie-Salpetriere Hospital (AP-HP), Sorbonne University, 75013 Paris, France
| | - Dominick J. Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL 32610, USA
| | - Mitchell W. Krucoff
- Department of Cardiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Nicolas M. Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Pieter C. Smits
- Department of Cardiology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Georgios J. Vlachojannis
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Cardiology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
- Department of Cardiology, Euroclinic Athens, 11521 Athens, Greece
| |
Collapse
|
3
|
Golwala H, Mamas MA. Direct stenting in ST segment elevation myocardial infarction: Are we there yet? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 41:151-153. [PMID: 35691833 DOI: 10.1016/j.carrev.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/15/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Harsh Golwala
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
| |
Collapse
|