Key result
Direct stenting achieved a higher rate of post-procedural TIMI grade 3 flow compared to standard stenting (92.8% vs 77.0%, P<0.005), while reducing radiation exposure and procedural costs.
Why the study?
Does direct coronary stenting improve coronary blood flow and reduce procedural costs compared to standard stenting in patients with coronary lesions?
Cohort (n=197)
Does direct coronary stenting improve coronary blood flow and reduce procedural costs compared to standard stenting in patients with coronary lesions?
Absolute Event Rate: 92.8% vs 77%
p-value: p=< 0.005
Direct coronary stenting is a safe procedure that improves immediate angiographic outcomes and reduces radiation exposure and costs compared to standard stenting.
May support direct stenting for better flow and efficiency in select lesions; leaves open confirmation in randomized trials.
Direct stenting (DS) was attempted in 99 coronary lesions in 94 patients while standard stenting (SS) was attempted in 113 lesions in 103 patients matched for clinical characteristics, stenosis type, and location and stent type. The angiographic result was also evaluated according to TIMI frame count method (TFC) before and after procedure. A clinical follow-up was performed 1 year after the procedure. Before the procedure, TIMI grade 3 flow was detected in 42 cases (42.4%), grade 2 in 40 cases (40.4%), grade 1 in 5 cases (5.1%), and grade 0 in 12 cases (12.1%) in the DS group; these data were similar in SS group. After the procedure, TIMI grade flow was 3 in 90 cases (92.8%) in DS group and in 87 (77.0%) in SS group (P < 0.005); grade 2 was observed in 7 case (7.2%) in DS group and in 25 (22.1%) in SS group (P < 0.005). Major adverse cardiac events during hospitalization and at follow-up were similar in two groups. Radiation exposure time and procedure costs per lesion were significantly reduced in DS group compared to SS group (10.1 +/- 8 min vs. 13.9 +/- 4.7 min, P < 0.001; and 1901 +/- 687 Euro vs. 2352 +/- 743 Euro, P < 0.001, respectively). This study confirms that, in selected patients, direct stenting is a safe and successful procedure, allowing a significant reduction in radiation exposure time and procedural costs compared to standard stenting technique. The angiographic success is confirmed by the improvement in TFC in all cases.
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Capozzolo et al. (2001) conducted a cohort in Coronary lesions (n=197). Direct stenting vs. Standard stenting was evaluated on TIMI grade 3 flow after procedure (p=< 0.005). Direct stenting achieved a higher rate of post-procedural TIMI grade 3 flow compared to standard stenting (92.8% vs 77.0%, P<0.005), while reducing radiation exposure and procedural costs.
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