A comparison of direct versus conventional stenting in patients undergoing primary angioplasty for ST-elevation myocardial infarction.

OBJECTIVE: The aim of our study was to determine the impact of direct stenting (DS) on procedural success and the in-hospital outcome among patients with ST-elevation myocardial infarction (STEMI) treated with a primary percutaneous coronary intervention (PCI). BACKGROUND: With improvements in stent designs, DS has become more widespread. The theoretical advantages of DS include a shorter procedural time, a lower contrast dose, and reduced spiral dissections, along with reduced radiation exposure and procedural costs. METHODS: A total of 1992 consecutive STEMI patients were reviewed; 621 patients (31.2%) were included in the DS group and 1371 (68.8%) in the conventional stenting (CS) group. The clinical and angiographic characteristics, in-hospital outcomes, and predictors of unsuccessful primary angioplasty were analyzed. RESULTS: The incidence of in-hospital major adverse cardiac events (MACE) was 6.1% in the CS group and 4.3% in the DS group. The difference between the two patient groups was not statistically significant for myocardial reinfarction (re-MI), target-vessel revascularization, and MACE. Nonetheless, the rates of in-hospital mortality and advanced heart failure were significantly lower in the DS group. CS [odds ratio (OR) 3.49, 95% confidence interval (CI) 1.65-7.37, P=0.001], Killip class 2/3 (OR 2.5, 95% CI 1.2-5.23, P=0.01), glomerular filtration rateless than 60 ml/min/1.73 m (OR 2.2, 95% CI 1.22-3.94, P=0.008), and anterior MI (OR 1.61, 95% CI 1.01-2.56, P=0.04) were found to be independent predictors of unsuccessful procedures. CONCLUSION: DS improves the in-hospital outcomes of STEMI patients treated with primary PCI, particularly by reducing the rates of in-hospital mortality and advanced heart failure. CS was an independent predictor of unsuccessful PCI.