Key result
Non-compliant balloon post-dilatation cuts 7-month incomplete strut apposition ~61% vs control in STEMI primary PCI.
Why the study?
Stent failure is more likely in lipid rich and thrombus laden culprit lesions in STEMI, and the effectiveness of post-dilatation in primary PCI for acute STEMI was assessed.
Does post-dilatation improve the rate of incomplete strut apposition in STEMI patients undergoing primary percutaneous coronary intervention?
RCT (n=41)
Single-blind
1:1
Yes
Does post-dilatation improve the rate of incomplete strut apposition in STEMI patients undergoing primary percutaneous coronary intervention?
Post-dilatation during primary PCI for STEMI significantly reduces incomplete stent strut apposition at 7 months without compromising coronary blood flow or increasing 1-year MACE.
Answers are grounded in this paper and cite their sources.
Post-dilatation improves strut apposition at 7 months after STEMI PCI; extends OCT data without affecting flow or 1-year MACE.
BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction (STEMI). This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention (pPCI) for acute STEMI. METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation. Patients were randomly assigned to control group (n=20) or post-dilatation group (n=21) in which a non-compliant balloon was inflated to >16 atm pressure. Strut apposition and coverage were evaluated by optical coherence tomography (OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up. The primary endpoint was rate of incomplete strut apposition (ISA) at 7 months after pPCI. RESULTS: There were similar baseline characteristics except for stent length (21.9 [SD 6.5] mm vs. 26.0 [SD 5.8] mm, respectively, P=0.03). In post-dilatation vs. control group, ISA rate was lower (2.5% vs. 4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate (95.2% vs. 95.0%, P>0.05) or corrected TIMI frame counts (22.6±9.4 vs. 22.0±9.7, P>0.05); and at 7-month follow-up (0.7% vs. 1.8%, P<0.0001), the primary study endpoint, with similar strut coverage (98.5% vs. 98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events (MACE). CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate. Larger and longer term studies are warranted to further assess safety (ClinicalTrials.gov identifier: NCT02121223).
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Jiang et al. (2020) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=41). Post-dilatation vs. Control (no post-dilatation) was evaluated on Rate of incomplete strut apposition (ISA) at 7 months after pPCI (p=<0.0001). Post-dilatation with a non-compliant balloon significantly reduced the rate of incomplete strut apposition at 7 months compared to control (0.7% vs. 1.8%, p<0.0001) in STEMI patients undergoing primary PCI.
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