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January 1, 2013Revista Brasileira de Cardiologia Invasiva (English Edition)Open Access

At 1 year, the MACE rate was similar between the direct stenting and pre-dilation groups (6.5% vs. 5.7%; P > 0.99).

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Why the study?

Does direct stenting reduce major adverse cardiac events compared to stenting with pre-dilation in patients with non-ST-segment-elevation acute coronary syndromes?

Population

182 patients with non-ST-segment-elevation acute coronary syndromes treated from 2009 to 2010. Mean age 61.1…

Comparison

Direct stenting of the target lesion vs Stenting with pre-dilation of the target lesion

Design

Cohort

Follow-up

1 year

Authors

JOJavier Obregón OblitasJCJ. Ribamar CostaDSDimytri Siqueira

Discussion

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Overview

Similar 1-year MACE rates do not support routine direct stenting in NSTE-ACS; leaves open individualized strategy selection by lesion complexity.

Key Points

  • To compare in-hospital and late clinical outcomes between direct stenting and stenting with pre-dilation in patients presenting with non-ST-segment elevation acute coronary syndromes.
  • Analyzed a single-center retrospective registry of 182 NSTE ACS patients treated between 2009 and 2010 (42.3% direct stenting).
  • Excluded patients undergoing stenting for bifurcation lesions, saphenous vein graft lesions, and in-stent restenosis.
  • Assessed periprocedural angiographic complications alongside in-hospital and 1-year major adverse cardiac events (MACE).
  • Patients treated with pre-dilation presented with more complex anatomy, including higher rates of type C lesions (37.1% vs. 18.2%, P = 0.01) and smaller reference vessel diameters (2.3 mm vs. 2.7 mm, P = 0.01).
  • Periprocedural angiographic complication rates did not differ significantly between direct stenting and pre-dilation (3.9% vs. 4.8%, P = 0.99).
  • In-hospital MACE occurred in 2.6% of the direct stenting group versus 5.7% of the pre-dilation group (P = 0.47), and 1-year MACE was 6.5% versus 5.7% (P > 0.99).

Structured PICO

Does direct stenting reduce major adverse cardiac events compared to stenting with pre-dilation in patients with non-ST-segment-elevation acute coronary syndromes?

P
Population
182 patients with non-ST-segment-elevation acute coronary syndromes (NSTE ACS) treated from 2009 to 2010. Mean age 61.1 ± 11.0 years, 67% male, 33.5% diabetics. Excluded: stenting for bifurcations, saphenous vein grafts, and in-stent restenosis.
I
Intervention
Direct stenting (stenting without pre-dilation) of the target lesion
C
Comparator
Stenting with pre-dilation of the target lesion
O
Outcome
In-hospital and late (1 year) major adverse cardiac events (MACE)composite

In patients with NSTE ACS, direct stenting was not associated with better angiographic or clinical outcomes compared to stenting with pre-dilation, though lesion complexity remains a determinant factor in strategy choice.

Cite This Study

Oblitas et al. (2013) studied this question.

synapsesocial.com/papers/6a6f84b6ac440176ef2831a6https://doi.org/10.1016/s2214-1235(15)30156-3
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