Procedural and long-term outcomes of stent post dilatation during primary percutaneous coronary interventions

Abstract

The role of stent post dilatation (SPD) during primary percutaneous intervention (PPCI) is controversial. Currently there are no clear guidelines or consensus regarding when to perform SPD and it is left to the operator decision. The aim of this study was to evaluate the procedural and long terms outcomes of SPD during PPCI. We collected retrospectively data of 614 STEMI patients who presented to two tertiary centers during one year period. All patients underwent PPCI. We excluded patients with cardiogenic shock, prior CABG, severe LM disease. Patients were divided into two groups according to SPD procedure. Group 1: who had SPD included 424 patients (69.1%). Group 2: no SPD included 190 patients (30.9%). Both groups were well matched with regard to demographic data and lesion characteristics. Procedural outcomes and clinical outcomes at one year were collected. SPD patients had significantly higher incidence of no reflow during the procedure (33.7% in group 1 vs. 21.6% in group 2, P=0.026), but the final TIMI flow was similar between two groups. Also, there was no significant difference between two groups regarding other procedural outcomes as dissection, perforation, or cardiac death. After one year follow up SPD patients had significantly higher incidence of reinfarction (5.6% of group 1 vs. 1.5% in group 2, P=0.03) and significantly more target vessel revascularization (TVR) (16.7% in group 1 vs. 4.7% in group 2 P<0.001). There was no significant difference between the two groups regarding the incidence cerebrovascular stroke (CVS), heart failure or cardiac death. Our study shows that SPD during PPCI is associated with an increased risk of procedural no reflow and increased risk of reinfarction as well as need for TVR after 1 year follow up. Finally, SPD did not improve clinical outcomes after 1 year follow up. Nonetheless, large-scale randomized trials are required to establish the role of SPD during PPCI. Type of funding sources: None.