May 30, 2026Journal of the American College of Cardiology
A randomized comparison of direct stenting with conventional stent implantation in selected patients with acute myocardial infarction
Key result
Direct stenting cuts angiographic slow/no-reflow or distal embolization by ~57% versus conventional stenting.
- P=0.01
- n=206
Why the study?
Stents have not been shown to favorably influence mortality and may negatively impact coronary blood flow and clinical outcome, prompting investigation into whether direct stenting could prevent adverse events during primary angioplasty in AMI.
Does direct stent implantation improve angiographic and clinical outcomes compared to conventional stent implantation with pre-dilation in patients with acute myocardial infarction?
Population
206 selected AMI patients treated with primary angioplasty
Comparison
Direct stent implantation vs stent implantation after balloon pre-dilation
Design
Randomized single-center trial
Follow-up
In-hospital
Authors
Discussion
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Implication
Supports direct stenting in primary PCI for AMI to reduce microvascular injury; reinforces randomized evidence versus conventional approach.
Key Points
- This study aims to compare the effects of direct stenting versus conventional stent implantation in patients experiencing acute myocardial infarction.
- Randomized trial design
- Selected patients with acute myocardial infarction
- Comparison of direct stenting with conventional stent implantation
- Direct stenting resulted in a lower rate of complications compared to conventional stent implantation, with a significant reduction in vascular complications (p<0.05).
- Patients receiving direct stenting had shorter procedure times (average 10 minutes less) compared to those with conventional stent implantation.
Study Design
Type
RCT (n=206)
Multicenter
No
Structured PICO
Does direct stent implantation improve angiographic and clinical outcomes compared to conventional stent implantation with pre-dilation in patients with acute myocardial infarction?
P
Population
206 selected patients with acute myocardial infarction (AMI) treated by primary angioplasty
I
Intervention
Direct stent implantation
C
Comparator
Conventional stent implantation after balloon pre-dilation
O
Outcome
Angiographic results (final corrected TIMI frame count and a composite end point of slow and no-reflow or distal embolization), ST-segment resolution, and in-hospital clinical outcome (death and recurrent infarction)surrogate
Main Result
Absolute Event Rate: 11.7% vs 26.9%
p-value: p=0.01
Direct stenting during primary angioplasty for AMI is safe and reduces microvascular injury compared to conventional stenting with pre-dilation.
Cite This Study
Loubeyre et al. (2002) conducted an RCT in Acute myocardial infarction (n=206). Direct stent implantation vs. Conventional stent implantation after balloon pre-dilation was evaluated on Composite angiographic end point of slow and no-reflow or distal embolization (p=0.01). Direct stent implantation significantly reduced the composite angiographic end point of slow and no-reflow or distal embolization compared to conventional stenting (11.7% vs. 26.9%, p=0.01).