Short‐term safety and long‐term benefits of stent postdilation after primary percutaneous coronary intervention: Results of a cohort study

• Published in: Catheterization and cardiovascular interventions Vol. 95; no. 7; pp. 1249 - 1256
• Main Authors: Saadat, Nasser, Saadatagah, Seyedmohammad, Aghajani Nargesi, Arash, Alidoosti, Mohammad, Poorhosseini, Hamidreza, Amirzadegan, Alireza, Lashkari, Reza, Mortazavi, Seyedeh Hamideh, Jalali, Arash, Ghodsi, Saeed, Salarifar, Mojtaba
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.06.2020; Wiley Subscription Services, Inc
• Subjects: Aged; Angioplasty; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - instrumentation; Angioplasty, Balloon, Coronary - mortality; Apposition; Clinical outcomes; Cohort analysis; Coronary Angiography; coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Female; Heart; Humans; Implants; Male; Middle Aged; Myocardial infarction; myocardial reperfusion injury; Myocardial Reperfusion Injury - etiology; Myocardial Reperfusion Injury - prevention & control; primary PCI; Recurrence; Retreatment; Risk Factors; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - therapy; stent postdilation; stenting technique; Stents; ST‐elevation myocardial infarction; Time Factors; Treatment Outcome; coronary artery disease; primary PCI; ST-elevation myocardial infarction; stenting technique; myocardial reperfusion injury; stent postdilation
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.28396

Aim Achieving the optimal apposition of coronary stents during percutaneous coronary intervention is not always feasible. The risks and benefits of stent postdilation in primary percutaneous coronary intervention (PPCI) in patients with ST‐elevation myocardial infarction (STEMI) have remained controversial. We sought to evaluate the immediate angiographic and long‐term outcomes in patients with and without stent postdilation. Methods A cohort of patients (n = 1,224) with STEMI, treated with PPCI (n = 500 postdilated; n = 724 controls), were studied. The flow grade, the myocardial blush grade, and the frame count were considered angiographic outcomes. The clinical outcomes were major adverse cardiovascular events (MACE)—comprising cardiac death, nonfatal MI, and repeat revascularization—and the device‐oriented composite endpoint (DOCE)—consisting of cardiac death, target lesion revascularization, and target vessel revascularization. Results The flow and myocardial blush grades were not different between the two groups, and the frame count was significantly lower in the postdilation group (15.7 ± 8.4 vs. 17 ± 10.4; p < .05). The patients were followed up for 348 ± 399 days. DOCE (2.2% vs. 5.8%) and cardiac mortality (1.2% vs. 3.2%) were lower in the postdilation group. In the fully adjusted propensity score‐matched analysis, postdilation was associated with decreased DOCE (HR = 0.40 [0.18–0.87], p = .021). Conclusions Selective postdilation improved some angiographic and clinical outcomes and could not be discouraged in PPCI on patients with STEMI.