Effect of Stent Inflation Pressure and Post-Dilatation on the Outcome of Coronary Artery Intervention. A Report of More than 90 000 Stent Implantations
Key result
Post-dilatation during coronary stent implantation was associated with a significantly higher risk of restenosis (RR 1.22) compared to procedures without post-dilatation.
Why the study?
Does stent inflation pressure and post-dilatation affect the risk of restenosis, stent thrombosis, and death in patients undergoing percutaneous coronary intervention?
Population
93,697 consecutive coronary stent implantations in Sweden from the Swedish Coronary Angiography and…
Comparison
Stent inflation pressures of ≤15 atm, 16-17 atm… vs Stent inflation pressure of 20-21 atm, and no…
Design
Cohort
Authors
Discussion
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Member takes
Implication
May increase restenosis risk in PCI; leaves open optimal pressure strategies for thrombosis and mortality in RCTs.
Study Design
Type
Observational (n=93,697)
Multicenter
Yes
Structured PICO
Does stent inflation pressure and post-dilatation affect the risk of restenosis, stent thrombosis, and death in patients undergoing percutaneous coronary intervention?
P
Population
93,697 consecutive coronary stent implantations in Swedish patients (mean age 67 years, 26% female) followed for approximately 2 years to evaluate the impact of stent inflation pressure and post-dilatation.
E
Exposure
Stent inflation pressures of ≤15 atm, 16-17 atm, 18-19 atm, and ≥22 atm, and the use of post-dilatation.
C
Comparator
Stent inflation pressure of 20-21 atm, and no post-dilatation.
O
Outcome
Restenosis, stent thrombosis, and death.hard clinical
Main Result
Relative Risk: 1.22 (95% CI 1.14–1.32)
p-value: p=<0.001
An optimal stent inflation pressure of 20-21 atm is associated with the lowest risk of stent thrombosis and restenosis, while post-dilatation is associated with lower mortality despite an increased restenosis risk.
Limitations
- Retrospective observational design with potential for unmeasured residual confounding.
- SCAAR definition of stent thrombosis excludes non-occlusive stent thrombosis.
- Lack of information on duration of stent inflation, vessel-to-balloon diameter ratio, and degree of calcification.
- Inability to specify whether non-compliant or semi-compliant balloons were used for post-dilatation.
- Retrospective study design
Cite This Study
Fröbert et al. (2013) conducted an observational in Coronary artery disease (n=93,697). Post-dilatation vs. No post-dilatation was evaluated on Restenosis (RR 1.22, 95% CI 1.14-1.32, p=<0.001). Post-dilatation during coronary stent implantation was associated with a significantly higher risk of restenosis (RR 1.22) compared to procedures without post-dilatation.