Key result
Stent post-dilatation in STEMI primary PCI brings ~2-fold higher risk of suboptimal final flow.
Why the study?
Stent post-dilatation is commonly used for optimal stent expansion during primary PCI for STEMI, but its effect on final TIMI flow and microvascular perfusion is unclear in low-resource settings such as Pakistan.
Does stent post-dilatation improve final TIMI flow in patients with STEMI undergoing primary PCI?
RCT (n=193)
Operator randomly assigned patients to two groups (1:1)
No
Does stent post-dilatation improve final TIMI flow in patients with STEMI undergoing primary PCI?
In a Pakistani cohort of STEMI patients undergoing primary PCI, routine stent post-dilatation was associated with lower rates of final TIMI 3 flow, increased no-reflow/slow-flow, and lower left ventricular ejection fraction.
Post-dilatation was associated with lower TIMI 3 flow in STEMI PCI; leaves open optimal deployment strategy pending randomized confirmation.
The common intervention for ST-segment elevation myocardial infarction is primary percutaneous coronary intervention (PCI). Post-dilatation of the stent is commonly used to obtain the best stent expansion, but its effect on end-tidal thrombolysis of myocardial infarction flow and microvascular perfusion is not clear in low-resource settings, e.g., Pakistan. Objectives: The study will assess the effectiveness of stent post-dilatation on end-TIMI flow in patients undergoing primary PCI in STEMI, and the relationship between stent post-dilatation and no-reflow and in-hospital outcome measures. Methods: The research was a prospective cohort study conducted in the department of cardiology, Sheikh Zayed Medical College/hospital, Rahim Yar Khan, in a span of four months. The non-probability consecutive sampling included 193 patients with STEMI undergoing primary PCI. The operator randomly assigned the patients to two groups: post-dilatation (n = 96) and no post-dilatation (n=97). Clinical measurements, angiographic, and echocardiographic measurements were obtained. Results: TIMI 3 flow during the last time was also achieved in 68.7/80.4% of the post-dilated group and non-post-dilated group, respectively (p=0.036). There was a higher incidence of no-reflow or slow-flow post-dilatation (19.8% vs 9.3, p=0.029). Mean ejection fraction was lower with post-dilatation (45.1 ± 7.8% vs 47.3 ± 7.0%, p=0.046). Suboptimal final TIMI flow was predicted by post-dilatation alone (OR 2.03, 95% CI 1.05–3.91, p=0.034). Conclusions: Post-dilatation stent in this Pakistani STEMI cohort was associated with lower final TIMI 3 flows and greater no-reflow, and was an independent predictor of suboptimal epicardial reperfusion after primary PCI.
No takes yet. Share an insight, caveat, or question.
Akram et al. (2026) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=193). Stent post-dilatation vs. No post-dilatation was evaluated on Final TIMI 3 flow (and prediction of suboptimal final TIMI flow) (OR 2.03, 95% CI 1.05-3.91, p=0.036). Stent post-dilatation during primary PCI for STEMI lowered final TIMI 3 flow vs no post-dilatation (68.7% vs 80.4%, p=0.036) and predicted suboptimal flow (OR 2.03, 95% CI 1.05-3.91).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: