Effect of direct stenting on microvascular dysfunction during percutaneous coronary intervention in acute myocardial infarction: a randomized pilot study

• Published in: Journal of international medical research Vol. 50; no. 9; p. 3000605221127888
• Main Authors: Kim, Byung Gyu, Cho, Sung Woo, Seo, Jongkwon, Kim, Gwang Sil, Jin, Moo-Nyun, Lee, Hye Young, Byun, Young Sup, Kim, Byung Ok
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.09.2022; Sage Publications Ltd; SAGE Publishing
• Subjects: Angioplasty; Clinical outcomes; Heart attacks; Prospective Clinical Research Report; Stents; Microcirculation; percutaneous coronary intervention; ST-elevation myocardial infarction; predilatation; direct stenting; index of microcirculatory resistance
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/03000605221127888

Objective Whether direct stenting (DS) without predilatation during primary percutaneous coronary intervention (PPCI) reduces microvascular dysfunction in patients with ST-elevation myocardial infarction is unclear. We performed a randomized study to assess the effect of DS on microvascular reperfusion. Methods Seventy-two patients undergoing PPCI were randomly assigned to the DS or conventional stenting (CS) with predilatation groups. The primary endpoint was the post-PPCI index of microcirculatory resistance (IMR). We compared thrombolysis in myocardial infarction myocardial perfusion (TMP) grades, ST-segment resolution, and long-term clinical outcomes between the groups. Results Microvascular reperfusion parameters immediately after PPCI (e.g., the IMR, TMP grade, and ST-segment resolution) were not different between the groups. However, significantly fewer patients in the DS group had the IMR measured because of no-reflow or cardiogenic shock during PPCI than those in the CS group. No differences were found in left ventricular functional recovery or clinical outcomes between the groups. Conclusions This trial showed no effect of DS on the IMR. However, our finding should be interpreted with caution because the number of patients who could not have the IMR measured was higher in the CS group than in the DS group. A larger randomized trial is required (Research Registry number: 8079).