Influence of direct stenting on the frequency of intraoperative complications and immediate treatment outcomes in patients with ST-elevation myocardial infarction

Authors: Sazanov G.V., Shugushev Z.Kh., Belokon O.S., Ermakov S.V., Pisarenko N.V.

Company: 1 Stavropol Regional Clinical Hospital, Stavropol, Russian Federation
2 RUDN University Moscow, Russian Federation

For correspondence:  Sign in or register.

Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2023-17-3-424-432

For citation: Sazanov G.V., Shugushev Z.Kh., Belokon O.S., Ermakov S.V., Pisarenko N.V. Influence of direct stenting on the frequency of intraoperative complications and immediate treatment outcomes in patients with STEMI. Creative Cardiology. 2023; 17 (3): 424–32 (in Russ.). DOI: 10.24022/1997-3187-2023-17-3-424-432

Received / Accepted:  25.08.2023 / 18.09.2023

Keywords: ST-elevation myocardial infarction percutaneous coronary phases no-reflow/slow-reflow phenomenon

Download
Full text:  

 

Abstract

Objective. To evaluate the immediate results of primary percutaneous coronary intervention in patients with STelevation myocardial infarction (STEMI) with preserved antegrade blood flow, depending on the performance of balloon predilatation before coronary stent implantation or direct stenting.

Material and methods. The study included 326 patients with STEMI and preserved antegrade blood flow (TIMI 1–3) during coronary angiography. The patients were divided into 2 groups: the first included 108 patients who underwent balloon predilatation before implantation of a coronary stent, and the second included 218 patients who underwent direct stenting of the infarct-associated coronary artery.

Results. The study found that direct stenting in patients with STEMI was characterized by a statistically significantly lower risk of slow- and no-reflow phenomenon (p=0.001, Pearson’s Chi-square) and, as a result, better functional outcomes of treatment of patients (the degree of chronic heart failure according to N.D. Strazhesko, V.Kh. Vasilenko and left ventricular ejection fraction), which were also statistically significant (p=0.001, Pearson’s Chi-square).

Conclusion. Direct stenting was a more favorable effect on the treatment outcomes of patients with STEMI, restoration of the contractile function of the left ventricle, and immediate clinical outcomes and can be considered in patients with STEMI and preserved antegrade blood flow (TIMI 1–3) as the method of choice for PCI in patients with STEMI.

References

  1. Alekyan B.G. Endovascular surgery. National leadership. In 4 vols. Moscow; 2017. Vol. 2: 399–426 (in Russ.).
  2. Sazanov G.V., Belokon O.S. The effect of predilation on the incidence of the no/slow-reflow phenomenon in patients with acute coronary syndrome with ST segment elevation. Kazan Medical Journal. 2020; 101 (2): 284–8 (in Russ.). DOI: 10.17816/KMJ2020-284
  3. Niccoli G., Ibanez B., Thiele H., Thiele H., Crea F., Heusch G. et al. Optimized treatment of ST-elevation myocardial infarction. Circ. Res. 2019; 125: 245–58. DOI: 10.1161/CIRCRESAHA.119.315344
  4. Коваль М. Феномен «no-reflow» – ложка дегтя в бочке меда реваскуляризации. Med. Review. 2008; 5: 32–6. Koval M. “No-reflow” phenomenon – a fly in the ointment of revascularization. Medicine Review. 2008; 5: 32–6 (in Russ.).
  5. Sazanov G.V., Shugushev Z.Kh., Belokon O.S., Ermakov S.V., Khripunova A.A. Dilation of the infarct-related coronary artery to reduce the incidence of the no-reflow phenomenon in STEMI patients. Innovative Medicine of Kuban. 2023; 3: 54–61 (in Russ.). DOI: 10.35401/2541-9897-2023-26-3-54-61
  6. Iskhakov M.M., Tagirova D.R., Gazizov N.V., NugaybekovaL.A., Sayfutdinov R.G. «No-reflow» phenomenon: clinical aspects of reperfusion failure. Kazan Medical Journal. 2015; 96 (3): 391–6 (in Russ.). DOI: 10.17750/KMJ2015-391
  7. Yaméogo N.V., Guenancia C., Porot G., Richard C., GudjoncikA. et al. Predictors of angiographically visible distal embolization in STEMI. Herz. 2020; 45 (3): 288–92. DOI: 10.1007/s00059-018-4723-1
  8. Remkes W.S., Somi S., Roolvink V., Rasoul S., Ottervanger J.P., Gosselink A.T.M. Direct drug-eluting stenting to reduce stent restenosis: a randomized comparison of direct stent implantation to conventional stenting with pre-dilation or provisional stenting in elective PCI patients. JACC Cardiovasc. Interv. 2014; 7 (7): 751–8. DOI: 10.1016/j.jcin.2014.02.012
  9. Namazi M., Mahmoudi E., Safi E., Jenab Y., Vakili H., Saadat H. et al. The No-reflow phenomenon: is it predictable by demographic factors and routine laboratory data? Acta. Biomed. 2021; 92 (5): 1202–97. DOI: 10.23750/abm.v92i5.10053
  10. Stiermaier S.M.T., Fuernau G., Pöss J., Waha-Thiele S., Desch S. et al. Impact of direct stenting on myocardial injury assessed by cardiac magnetic resonance imaging and prognosis in STelevation myocardial infarction. Int. J. Cardiol. 2019; 283: 88– 92. DOI: 10.1016/j.ijcard.2018.11.141
  11. Ibanez B., James S., Agewall S., Antunes M.J., BucciarelliDucci C., Bueno H. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur. Heart J. 2018; 39: 119–77. DOI: 10.1016/j.rec.2017.11.010
  12. Kim B.G., Cho S.W., Seo J., Kim G.S., Jin M.N., Lee H.Y. et al. Effect of direct stenting on microvascular dysfunction during percutaneous coronary intervention in acute myocardial infarction: a randomized pilot study. J. Int. Med. Res. 2022; 50 (9): 1–9. DOI: 10.1177/03000605221127888
  13. Jolly S.S., Cairns J.A., Yusuf S., Meeks B., Pogue J., Rokoss M.J. et al. Randomized trial of primary PCI with or without routine manual thrombectomy. N. Engl. J. Med. 2015; 372: 1389–98. DOI: 10.1056/NEJMoa1415098
  14. Loubeyre C., Morice M.C., Lefevre T., Piéchaud J.-F., Louvard Y., Dumas P. et al. A randomized comparison of direct stenting with conventional stent implantation in selected patients with acute myocardial infarction. J. Am. Coll. Cardiol. 2002; 39: 15–21. DOI: 10.1016/s0735-1097(01)01701-6
  15. Sabatier R., Hamon M., Zhao Q.M., Burzotta F., Lecluse E., Valette B., Grollier G. Could direct stenting reduce noreflow in acute coronary syndromes? A randomized pilot study. Am. Heart J. 2002; 143: 1027–32. DOI: 10.1067/mhj.2002.122509
  16. Ballarino M.A., Moreyra E., Jr., Damonte A., Sampaolesi A., Woodfield S., Pacheco G. et al. Multicenter randomized comparison of direct vs. conventional stenting: the DIRECTO trial. Catheter. Cardiovasc. Interv. 2003; 58: 434–40. DOI: 10.1002/ccd.10404
  17. Gasior M., Gierlotka M., Lekston A., Wilczek K., Zebik T., Hawranek M. et al. Comparison of outcomes of direct stenting versus stenting after balloon predilation in patients with acute myocardial infarction (DIRAMI). Am. J. Cardiol. 2007; 100: 798–805. DOI: 10.1016/j.amjcard.2007.04.026
  18. Ozdemir R., Sezgin A.T., Barutcu I., Topal E., Gullu H., Acikgoz N. et al. Comparison of direct stenting versus conventional stent implantation on blood flow in patients with ST-segment elevation myocardial infarction. Angiology. 2006; 57: 453–8. DOI: 10.1177/0003319706290620
  19. Alak A., Lugomirski P., Aleksova N., Jolly S.S. A meta-analysis of randomized controlled trials of conventional stenting versus direct stenting in patients with acute myocardial infarction. J. Inv. Cardiol. 2015; 27: 405–9.
  20. Annibali G., Scrocca I., Aranzulla T.C., Meliga E., Maiellaro F., Musumeci G. et al. “No-Reflow” phenomenon: a contemporary review. J. Clin. Med. 2022; 11: 2233. DOI: 10.3390/jcm11082233

About Authors

  • Grigoriy V. Sazanov, Endovascular Surgeon; ORCID
  • Zaurbek Kh. Shugushev, Dr. Med. Sci., Associate Professor, Chief of Chair; ORCID
  • Oleg S. Belokon, Cand. Med. Sci., Head of Department, Endovascular Surgeon; ORCID
  • Sergey V. Ermakov, Cand. Med. Sci., Neurologist, Endovascular Surgeon; ORCID
  • Nikolay V. Pisarenko, Endovascular Surgeon; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery