Key result
Direct stenting in OCT-guided primary PCI shows similar in-hospital MACE while lowering contrast and procedure time.
Why the study?
The role of direct stenting during primary PCI in the era of advanced intravascular imaging remains incompletely defined, including its determinants and impact on procedural efficiency and OCT-defined stent implantation quality in STEMI.
Does direct stenting improve procedural efficiency and OCT-defined stent implantation quality without compromising clinical outcomes compared to conventional stenting with balloon predilatation in patients undergoing OCT-guided primary PCI for STEMI?
Observational (n=436)
Single-blind (independent core laboratory and clinical events committee blinded)
Yes
Does direct stenting improve procedural efficiency and OCT-defined stent implantation quality without compromising clinical outcomes compared to conventional stenting with balloon predilatation in patients undergoing OCT-guided primary PCI for STEMI?
Absolute Event Rate: 2.9% vs 4.4%
p-value: p=0.611
In contemporary OCT-guided primary PCI for STEMI, direct stenting is primarily driven by operator preference and larger vessel size, offering reduced contrast volume and shorter procedure times without compromising stent expansion or 1-year clinical safety.
May support direct stenting to cut contrast and time in OCT-guided primary PCI; leaves open effects on stent quality and longer-term outcomes.
Background: Direct stenting (DS) is a simplified strategy for primary percutaneous coronary intervention (PCI); however, its role in the era of advanced intravascular imaging remains incompletely defined. We aimed to identify determinants of DS use and its impact on procedural efficiency and optical coherence tomography (OCT)-defined stent implantation quality in ST-elevation myocardial infarction (STEMI).
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Usui et al. (2026) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=436). Direct stenting (stenting without balloon predilatation) vs. Conventional stenting (stenting with balloon predilatation) was evaluated on In-hospital major adverse cardiovascular events (MACE: composite of all-cause death, non-fatal myocardial infarction, and target vessel revascularization) (p=0.611). Direct stenting in OCT-guided primary PCI reduced contrast volume (134 vs. 173 mL, P<0.001) and procedure time (65 vs. 82 min, P<0.001) with similar in-hospital MACE (2.9% vs. 4.4%, P=0.611).
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