Elsevier

American Heart Journal

Volume 143, Issue 6, June 2002, Pages 1027-1032
American Heart Journal

Clinical Investigations: Interventional Cardiology
Could direct stenting reduce no-reflow in acute coronary syndromes? A randomized pilot study,☆☆

https://doi.org/10.1067/mhj.2002.122509Get rights and content

Abstract

Objectives Recently, direct stenting has been shown in retrospective and randomized studies to be feasible and safe in highly selected patients, with a potential interest to reduce the cost of the procedure and the rate of no-reflow. This randomized pilot study was designed to compare the incidence of no-reflow after direct stenting or conventional stenting after balloon predilation in acute coronary syndrome-related lesions. Methods and Results Between December 1998 and October 1999, 130 patients in our center with acute coronary syndromes were included in this study and randomized in 2 groups. In group A (n = 65), direct stent implantation was performed without balloon predilation. In group B (n = 65), conventional balloon predilation was carried out before stent implantation. Baseline clinical and angiographic characteristics before the procedure were similar in the 2 groups of patients. No-reflow was observed in 7.7% after direct stenting and in 6.1% after conventional stent implantation (P = not significant). The immediate clinical success rate was similar in the 2 groups. Among the procedural data, only duration of the procedure (shorter in the direct stenting group), the number of balloons used, and the quantity of contrast agent (lower in the direct stenting group) were significantly different between the 2 groups (P <.05). The 6-month clinical outcome was similar in the 2 groups. Conclusion This randomized study confirms the promising results of previous studies that show the feasibility and the safety of direct coronary stenting in highly selected acute coronary syndrome-related lesions. The major impact of this strategy is the improvement of the cost-benefit ratio, with no major influence on the acute complications and especially on the occurrence of no-reflow in this high-risk population. (Am Heart J 2002;143:1027-32.)

Section snippets

Study design

This randomized study was designed to detect a reduction in the incidence of no-reflow after direct stenting with comparison with conventional stenting in the treatment of acute coronary syndrome-related lesions. From an observational study previously published,5 we hypothetized that in acute coronary syndromes the incidence of no-reflow in this high risk population could be reduced from 18% to 2% with direct stenting. The primary end point was the reduction of the no-reflow defined below. We

Clinical and angiographic characteristics

One hundred and thirty patients with a mean age of 61 ± 13 years (range, 36 to 84 years) were studied. These selected patients represented 34% of all patients treated with percutaneous transluminal coronary angioplasty and stent for an acute coronary syndrome during the same period in our center. Indications for angioplasty were recent myocardial infarction in 61% (63% acute infarction <12 hours) and unstable angina in 39% of the cases. Thrombolysis was performed in 37% of the patients with

Discussion

In this study, we showed that in a highly selected population direct stenting is a safe and economic strategy in acute coronary syndrome-related lesions. No significant effect was found concerning the reduction of the no-reflow phenomenon as shown with the TIMI flow grade and the comparison of the CTFC.

Recent improvements in stent implantation with high-pressure stent deployment17 and combinations of antiplatelet agents18 have led to a dramatic improvement in success rates, justifying the use

Acknowledgements

We thank Pierre Rayroles, General Director of the University Hospital of Caen, for his great support in the development of this study.

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Reprint requests: Martial Hamon, MD, Service des Maladies du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Caen, Côte de Nacre, 14033 Caen, France.

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E-mail: [email protected]

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