Direct stenting versus stenting after predilatation or manual thromboaspiration in patients with acute ST-segment elevation myocardial infarction and complete thrombotic occlusion of the infarct-related coronary artery
Objective. To evaluate outcomes of direct stenting (DS) compared with stenting after predilation (PD) and/or manual thrombus aspiration (TA) in ST-elevation miocardial infarction (STEMI) patients with totally occluded culprit coronary artery. Material and methods. Data were collected from all patients (n = 1469) with STEMI admitted to the coronary care unit and submitted to percutaneous coronary interventions (PCI) from 2006 to 2016. A total of 931 patients with totally occluded culprit arteries were included in the analysis; 343 (36.8%) patients who received DS were compared with 588 (63.2%) patients who received non-DS. Among non-DS group 507 (86.2%) patients inderwent stenting after PD, 39 (6.6%) - TA, and 42 (7.1%) - stenting after combination of PD and TA. Results. In DS group, the rate of angiographic success was higher (96.5% vs. 88.6%, р <.001), and the rate of noreflow (2.6% vs. 10.5%, р <.001) was lower. The mortality (2.9% vs. 6.8%, р =.011) and major adverse cardiovascular events (4.4% vs. 9%, р =.009) rates were significantly lower in DS-group. There were no differences in the frequency of stent thrombosis (1.2% vs. 1.5%, р=.777) and recurrent myocardial infarction (0.9% vs. 1.9%, р =.228). After multivariate adjustment, DS was an independent association with no-reflow phenomenon (OR 0.25; 95% CI 0.12-0.52, р<.0001). Conclusion. Direct stenting strategy in STEMI patients with totally occluded culprit coronary arteries is a safe and feasible technique. DS was associated with a decrease in the frequency of the no-reflow phenomenon during PCI.