What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction with low attenuation plaque (n=336). Intervention: Single-step long balloon inflation (≥60 s) vs. Conventional balloon inflation (<60 s or multi-step). Primary outcome: Achievement of final TIMI flow grade 3 (p=1.00).

September 29, 2025Circulation Reports2 citationsOpen Access

Long Inflation at Stent Deployment in Intravascular Ultrasound-Guided Percutaneous Coronary Intervention for Acute Myocardial Infarction

Q: What are the key findings of this study?

Single-step long balloon inflation resulted in a similar rate of final TIMI 3 flow (90.0% vs 88.5%) but a significantly greater delta TIMI flow grade compared to conventional inflation.

YWYûsuke Watanabe KSKenichi Sakakura HJHiroyuki Jinnouchi

Key Result

Single-step long balloon inflation resulted in a similar rate of final TIMI 3 flow (90.0% vs 88.5%) but a significantly greater delta TIMI flow grade compared to conventional inflation.

Study Design

Type

Cohort (n=336)

Multicenter

Structured PICO

Does single-step long balloon inflation during stent deployment improve final TIMI flow grade in AMI patients undergoing IVUS-guided PCI?

Population

336 patients with acute myocardial infarction and low attenuation plaque on intravascular ultrasound who underwent primary percutaneous coronary intervention, evaluated retrospectively for in-hospital outcomes.

Exposure

Single-step long balloon inflation (≥60 seconds) at stent deployment during IVUS-guided percutaneous coronary intervention (n=50)

Comparator

Conventional balloon inflation at stent deployment during IVUS-guided percutaneous coronary intervention (n=286)

Outcome

Achievement of the final TIMI flow grade 3 and the delta TIMI flow grade (difference between the initial and final grades)surrogate

Single-step long balloon inflation (≥60 seconds) during stent deployment in AMI patients with attenuation plaque improves delta TIMI flow grade, offering a feasible method to optimize angiographic outcomes.

Main Result

Absolute Event Rate: 90% vs 88.5%

p-value: p=1.00

Limitations

Single-center retrospective design with inherent risk of selection bias
Small sample size in the long inflation group (n=50)
Included both STEMI and NSTEMI without separate analysis due to sample size
Differences in baseline clinical severity and vasodilator usage between groups
Arbitrary 60-second cut-off for defining long inflation

Abstract

Background: There is a substantial risk of slow flow during percutaneous coronary intervention (PCI) for the culprit lesion in acute myocardial infarction (AMI), which can lead to adverse outcomes. We hypothesized that single-step long balloon inflation during stent deployment was associated with a more favorable final Thrombolysis in Myocardial Infarction (TIMI) flow grade. This retrospective study aimed to compare both the final TIMI flow grade and the delta TIMI flow grade in intravascular ultrasound (IVUS)-guided PCI for AMI between patients with long balloon inflation and those with conventional inflation. Methods and Results: Long inflation was defined as single-step inflation ≥60 s at stent deployment. The primary endpoints were achievement of the final TIMI flow grade 3 and the delta TIMI flow grade, defined as the difference between the initial and final grades. We analyzed 336 AMI patients with attenuation plaque on IVUS, dividing them into a long inflation group (n=50) and a conventional inflation group (n=286). Despite a significantly higher TIMI thrombus grade in the long inflation group (P<0.001), the rate of the final TIMI 3 flow was similar (90% vs. 88.5%; P=1.00). However, the delta TIMI flow grade was significantly greater in the long inflation group (P=0.028). Conclusions: Single-step long balloon inflation may be a simple and feasible method to achieve optimal final TIMI flow in IVUS-guided PCI for AMI.

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