Key result
Stepwise stent deployment reduced no-reflow compared to conventional stenting (HR for conventional 1.43; 95% CI 1.15-1.73; p=0.01) and lowered in-hospital mortality (2% vs 7.5%; p=0.01).
Why the study?
Does stepwise stent deployment reduce no-reflow and in-hospital mortality compared to conventional stent deployment in patients with anterior AMI undergoing early PCI?
RCT (n=403)
randomly divided
Yes
Does stepwise stent deployment reduce no-reflow and in-hospital mortality compared to conventional stent deployment in patients with anterior AMI undergoing early PCI?
Stepwise stent deployment during early PCI for anterior AMI significantly improves angiographic reperfusion and reduces in-hospital mortality compared to conventional stenting.
Answers are grounded in this paper and cite their sources.
Supports stepwise deployment in anterior AMI PCI; extends RCT evidence for optimized stenting to reduce no-reflow.
OBJECTIVE: To detect a reduction in the incidence of no-reflow, and a possible improvement in angiographic and clinical outcome after stepwise stenting in comparison with conventional method in the percutaneous coronary intervention (PCI) of patients with anterior ST elevation myocardial infarction. METHODS: Between March 2007 and December 2009, patients with anterior acute myocardial infarction (AMI) treated with streptokinase less than 6 hours from presentation who underwent early PCI were enrolled in this multicenter randomized clinical trial. The study was carried out in the Cardiology Departments of Valiasr Hospital of Zanjan, Imam Reza, and Shahid Madani Heart Hospitals, Tabriz, Iran. RESULTS: Four hundred and three patients were enrolled in this study. Patients were randomly divided into 2 groups: Group I (n=202) with stepwise stent deployment (SSD), and Group II (n=201) with routine conventional stent deployment (CSD). The patients' mean age was 57.7 +/- 10.7 years. After PCI, thrombolysis in myocardial infarction myocardial perfusion grade (TMPG) 0/1, suggestive of no-reflow was significantly higher in CSD group (p=0.0001). In hospital based, death occurred in 15 patients (7.5%) from CSD group while 4 (2%) from the SSD group (p=0.01). The TMPG was also significantly higher in SSD group (average 2.32 +/- 0.18) compared with CSD group, (average 1.66 +/- 0.24) (p=0.0001). Conventional stenting technique was an independent predictor of no-reflow in multivariate logistic regression analysis (hazard ratio - 1.43; 95% confidence interval: 1.15-1.73; p=0.01). CONCLUSION: The SSD was associated with improved angiographic reperfusion indices and reduced mortality in early PCI for AMI.
No takes yet. Share an insight, caveat, or question.
Sohrabi et al. (2011) conducted an RCT in anterior acute myocardial infarction (n=403). stepwise stent deployment vs. routine conventional stent deployment was evaluated on incidence of no-reflow (HR 1.43, 95% CI 1.15-1.73, p=0.01). Stepwise stent deployment reduced no-reflow compared to conventional stenting (HR for conventional 1.43; 95% CI 1.15-1.73; p=0.01) and lowered in-hospital mortality (2% vs 7.5%; p=0.01).
Synapse has enriched 10 related papers. Consider them for comparative context: