Key result
Primary stenting of coronary arteries in patients with STEMI significantly reduced the rate of cardiovascular complications at 12 months to 15% compared to 66.7% in patients without revascularization.
Why the study?
The predictive effect of primary coronary stenting on clinical course and left ventricular remodeling in STEMI patients with LV diastolic dysfunction remained to be determined at 12 months.
Does primary stenting of coronary arteries improve left ventricular remodeling and clinical outcomes in patients with acute STEMI compared to conservative management?
Cohort (n=100)
No
Does primary stenting of coronary arteries improve left ventricular remodeling and clinical outcomes in patients with acute STEMI compared to conservative management?
Absolute Event Rate: 15% vs 66.7%
p-value: p=<0.05
Primary PCI in STEMI patients significantly mitigates adverse left ventricular remodeling, lowers NT-proBNP, and reduces cardiovascular complications at 12 months compared to conservative management.
Supports primary stenting in STEMI; hypothesis-generating and leaves open confirmation in randomized trials.
OBJECTIVE: The aim: To determine the predictive effect of primary stenting of coronary artery on the clinical course and features of left ventricular remodeling in patients with acute myocardial infarction (MI) with ST segment elevation and LV diastolic dysfunction (DD) in the remote period (12 months). PATIENTS AND METHODS: Materials and methods: The study included 80 patients with STEMI who undergo primary PCI (group 1) and 20 patients with STEMI who did not undergo myocardial revascularization (group 2). In both groups, the levels of NT-proBNP were determined, echocardiography, bicycle ergometry; quality of life was determined according to SAQ questionnaire scales; marked cardiovascular complications. Patients were re-examined after 12 months. RESULTS: Results: The average level of NT-proBNP for 5 days and 12 months of patients in group 1 significantly decreased - 434.6 ± 36.3 and 122.8 ± 4.13 g / ml (p <0.001), indicating a less pronounced late remodeling of LV in patients undergoing revascularization with STEMI. Diastolic function was evaluated by E/A and DT. After 12 months, the 1st group was markedly lower than E/A and DT compared to the 2nd - 0.76 ± 0.03 and 198 ± 4.7 m / s and 1.49 ± 0.01 and 135 , 3 ± 2.91 m/s, respectively (p <0.05), which characterizes a decrease in the parameters of the DD by the type of the relaxation processes of the left ventriculi. Patients in Group 1, according to SAQ scales, had better quality of life and higher exercise tolerance at I-II level than patients without revascularization. CONCLUSION: Conclusions: In patients with STEMI, after a primary stenting of coronary artery, a significantly lower NT-proBNP level and less pronounced DD manifestations in the long-term (12 months) period demonstrated a better tolerance to physical activity and improved quality of life, as determined by the SAQ questionnaire and a lower rate of development cardiovascular complications.
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Melen et al. (2020) conducted a cohort in Acute ST segment elevation myocardial infarction (STEMI) (n=100). Primary stenting of coronary artery (PCI) vs. No myocardial revascularization was evaluated on Cardiovascular complications at 12 months (p=<0.05). Primary stenting of coronary arteries in patients with STEMI significantly reduced the rate of cardiovascular complications at 12 months to 15% compared to 66.7% in patients without revascularization.
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