Direct Stent Implantation in Acute Coronary Syndrome

Intracoronary stents have been a major milestone in interventional cardiology ever since two large, randomized trials1,2 documented that they reduced restenosis and repeat revascularization rates and increased event-free survival at 6 months. Recent improvements in stent implantation techniques3 and a combination of potent antiplatelet agents,4 such as glycoprotein IIb/IIIa inhibitors, have led to a dramatic improvement in success rate, justifying the stenting of most patients undergoing intervention, even when it is performed in thrombus-containing lesions (which are no longer regarded as lesions for stenting). However, no-reflow may still occur after stenting with predilatation and significantly limit the clinical benefit of the procedure in patients with acute coronary syndrome (ACS).5,6 *isubendsubAtmaca1.jpgAtmaca2.jpgAtmaca3.jpgAtmaca4.jpg** The baseline demographic characteristics of the study population are shown in Table 1. The patients in group I were younger (p = 0.03) and had a higher frequency of hypertension (p = 0.02) than in group II. The study population was well matched with respect to other baseline demographic features. Primary and overall success rate. Inability to cross the lesion occurred in 4 patients in group I. In 2 cases, the stent was lost in the systemic circulation with no further complications. In the remaining 2 cases, the stent was safely withdrawn without stent loss or damage, and after predilatation the same stent was successfully implanted. Therefore, the crossover rate was 2.8% in group I. In 4 cases in group I and 4 cases in group II, a dissection distal to the stent implantation was observed immediately after stenting and covered by further stenting. Therefore, the primary success rate was 89% in group I and 95% in group II and overall procedural success rate was 94% in group I and 100% in group II. Final angiographic success (Clinical outcomes: Primary study endpoints. Seven patients with Q-wave myocardial infarction in group I and 4 patients with Q-wave myocardial infarction in group II underwent primary percutaneous transluminal coronary angioplasty (PTCA) and stent implantation. A total of 169 lesions were treated with a 153 stents (75 stents in group I and 78 stents in group II). Of the 153 stents, sixty-two were Multi-Link Tristar or Tetra, sixty-five were Hexacath, sixteen were Jostent and 10 were AVE GFX stents. Baseline angiographic features of the two groups were similar. The study population was well matched with respect to baseline angiographic features as shown in Table 2. Clinical outcomes: Secondary study endpoints. The RET, total BIT, and NBI were significantly lower in group I than in group II (p

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