Direct stenting reduced 15-year all-cause mortality (aHR 0.74) compared to conventional stenting in patients presenting with ST-segment elevation myocardial infarction.
Observational (n=806)
No
Does direct stenting reduce long-term mortality and major adverse cardiac events in patients with STEMI undergoing percutaneous coronary intervention compared to conventional stenting?
Direct stenting during primary PCI for STEMI is associated with reduced 15-year all-cause mortality compared to conventional stenting, particularly in patients with impaired baseline TIMI flow.
Effect estimate: aHR 0.74 (95% CI 0.58-0.93)
Absolute Event Rate: 35% vs 45.3%
p-value: p=0.010
BACKGROUND/PURPOSE: Direct Stenting (DS) could be associated with reduced distal embolization and improved reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). However, the impact of DS on long-term outcomes remains unclear, therefore we evaluated the impact of DS on very long-term clinical outcome in STEMI. METHODS/MATERIALS: Between April 2002 and December 2004, patients presenting with STEMI undergoing percutaneous coronary intervention were investigated. The study population was divided into two groups: DS and conventional stenting (CS) and stratified according to initial TIMI flow. Major adverse cardiac events (MACE) were assessed at 10 years and all-cause mortality at 15 years. Cox proportional hazards models were used. When the proportional hazards assumption was not satisfied, landmark analysis at mid-term (2 years) was performed. RESULTS: A total of 812 consecutive patients were evaluated, 6 patients were excluded due to inadequate angiographic images, 450 (55.8%) underwent DS and 356 (44.2%) CS. At 15 years follow-up, DS was associated with a reduction in all-cause mortality (DS 35.0% vs. CS 45.3%, aHR 0.74, 95% CI 0.58-0.93, p = 0.010). The landmark analysis at 2 years identifies reduced 2-year MACE in DS compared with CS (6.8% vs.14%, aHR 0.67, 95% CI 0.49-0.93, p = 0.015) and beyond 2 years no significant differences were found between the groups (27.4% vs. 29.3%, aHR 1.00, 95% CI 0.74-1.36, p = 0.999). In patients with baseline TIMI 0-1, DS was associated with lower 10-year MACE and 15-year mortality compared with CS (aHR0.71, 95%CI 0.55-0.92, p = 0.010 and aHR0.65, 95%CI 0.50-0.84, p = 0.001, respectively). CONCLUSIONS: DS was associated with reduced 15-year all-cause mortality and reduced mid-term MACE rate in patients with STEMI. Clinical events reduction associated with DS was particularly relevant in patients with initial TIMI flow 0-1.
Scarparo et al. (2022) conducted an observational in ST-Segment Elevation Myocardial Infarction (n=806). Direct stenting vs. Conventional stenting was evaluated on All-cause mortality at 15 years (aHR 0.74, 95% CI 0.58-0.93, p=0.010). Direct stenting reduced 15-year all-cause mortality (aHR 0.74) compared to conventional stenting in patients presenting with ST-segment elevation myocardial infarction.