REVIEW

A quantitative estimate of bare-metal stenting compared with balloon angioplasty in patients with acute myocardial infarction: angiographic measures in relation to clinical outcome

Tone Svilaas, Iwan C C van der Horst, Felix Zijlstra

Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Correspondence to:
Correspondence to:
T Svilaas
Thoraxcenter, Department of Cardiology, University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700 RB Groningen, The Netherlands; t.svilaas{at}thorax.umcg.nl

We performed a systematic review of all randomised controlled trials (RCTs) from the pre-drug-eluting-stent era comparing bare-metal stenting (BMS) with balloon angioplasty in patients with acute myocardial infarction (MI) to examine coronary angiographic parameters of infarct-related vessel patency and to relate the angiographic measures to clinical outcome. The search was restricted to published RCTs in humans. 10 RCTs, (6192 patients) were analysed. Compared with balloon angioplasty, BMS was associated with reduced rates of reocclusion (6.7% vs 10.1%, OR 0.62, 95% CI 0.40 to 0.96, p = 0.03) and restenosis (23.9% vs 39.3%, OR 0.45, 95% CI 0.34 to 0.59, p<0.001), but not with reduced rates of subacute thrombosis (1.7% in both groups). BMS showed a reduction in target vessel revascularisation (TVR; 12.2% vs 19.2%, OR 0.50, 95% CI 0.37 to 0.69, p<0.001), but not in mortality (5.3% vs 5.1%) or reinfarction (3.9% vs 4%). The findings of this study support BMS placement in acute MI. The discrepancy between angiographic and clinical parameters has important implications for future studies investigating further technical improvements in mechanical reperfusion therapy.

Abbreviations: BMS, bare-metal stent; CABG, coronary artery bypass grafting; MI, myocardial infarction; PCI, percutaneous coronary intervention; PAMI, Primary Angioplasty in Myocardial Infraction; RCT, randomised controlled trial; TIMI, thrombolysis in myocardial infarction; TVR, target vessel revascularisation

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