Post-dilatation improves stent apposition in patients with ST-segment elevation myocardial infarction receiving primary percutaneous intervention: A multicenter, randomized controlled trial
10.5847/wjem.j.1920-8642.2020.02.004
- Author:
Jun Jiang
1
;
Nai-liang Tian
2
;
Han-bin Cui
3
;
Chang-ling Li
1
;
Xian-bao Liu
1
;
Liang Dong
1
;
Yong Sun
1
;
Xiao-min Chen
3
;
Shao-liang Chen
2
;
Bo Xu
4
;
Jian-an Wang
1
Author Information
1. Department of Cardiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
2. Department of Cardiology, Nanjing First Hospital, Nanjing, China
3. Department of Cardiology, Ningbo First Hospital, Ningbo, China
4. Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
- Publication Type:Journal Article
- Keywords:
ST-segment elevation myocardial infarction;
Post-dilatation;
Incomplete strut apposition;
Optical coherence tomography
- From:
World Journal of Emergency Medicine
2020;11(2):87-92
- CountryChina
- Language:English
-
Abstract:
BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction (STEMI). This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention (pPCI) for acute STEMI.
METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation. Patients were randomly assigned to control group (n=20) or post-dilatation group (n=21) in which a non-compliant balloon was inflated to >16 atm pressure. Strut apposition and coverage were evaluated by optical coherence tomography (OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up. The primary endpoint was rate of incomplete strut apposition (ISA) at 7 months after pPCI.
RESULTS: There were similar baseline characteristics except for stent length (21.9 [SD 6.5] mm vs. 26.0 [SD 5.8] mm, respectively, P=0.03). In post-dilatation vs. control group, ISA rate was lower (2.5% vs. 4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate (95.2% vs. 95.0%, P>0.05) or corrected TIMI frame counts (22.6±9.4 vs. 22.0±9.7, P>0.05); and at 7-month follow-up (0.7% vs. 1.8%, P<0.0001), the primary study endpoint, with similar strut coverage (98.5% vs. 98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events (MACE).
CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate. Larger and longer term studies are warranted to further assess safety (ClinicalTrials.gov identifi er: NCT02121223).
