Open AccessDirect stenting in patients with ST-elevation myocardial infarction and hyperglycemia
Author(s) -
И. С. Бессонов,
В. А. Кузнецов,
Е. А. Горбатенко,
И. П. Зырянов,
Stanislav Sapozhnikov,
А. О. Дьякова
Publication year - 2019
Publication title -
patologiâ krovoobraŝeniâ i kardiohirurgiâ/patologiâ krovoobrašeniâ i kardiohirurgiâ
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.136
H-Index - 3
eISSN - 2500-3119
pISSN - 1681-3472
DOI - 10.21688/1681-3472-2019-1s-s44-s52
Subject(s) - medicine , mace , myocardial infarction , percutaneous coronary intervention , cardiology , conventional pci , coronary stenting , stent , thrombus , thrombosis , restenosis
Aim. To evaluate in-hospital outcomes of direct stenting compared with stenting after predilation in patients with ST-elevation myocardial infarction and hyperglycemia at admission.Methods. Data were collected from hospital database, which includes information about all patients (n = 1 469) with ST-elevation myocardial infarction admitted to the coronary care unit and submitted to percutaneous coronary intervention. Plasma glucose was measured at hospital admission. Hyperglycemia was defined as plasma glucose of 7.77 mmol/L (140 mg/dL), regardless of the diabetic status. A total of 695 (46.3%) patients with hyperglycemia at admission were included in the analysis. Direct stenting (DS) was performed in 358 (51.5%) patients and 337 (48.5%) patients received stenting non-direct stenting. Among non-direct stenting group 292 (86.6%) patients received stenting after predilation, 19 (5.6%) patients received manual thrombus aspiration and 26 (7.7%) patients received stenting after combination of predilation and thrombus aspiration. The clinical and angiographic characteristics, in-hospital outcomes, as well as predictors of angiographic no-reflow were analysed. The composite of in-hospital death, myocardial infarction, and stent thrombosis were defined as major adverse cardiac events (MACE). Results. The rate of angiographic success was higher in DS group (96.1% vs. 89%, р<0,001). There were no difference in rates of stent thrombosis (1.1% vs. 0.9%, р = 0.764), repeat myocardial infarction (1.7% vs. 1.2%, р = 0,588), and access site complications (3.4% vs. 5.4%, р = 0.194) between groups. The rates death (3.9% vs. 9.5%, р = 0.003), MACE (5.3 vs. 11.3, р = 0.004), and no-reflow (2.2% vs. 11%, р<0.001) were significantly lower in the direct stenting group. Following propensity score matching, each group contained 160 patients. The rate of no-reflow (3.1% vs. 10.0%, р = 0.013) remain significantly lower in the DS group. There were no differences in rates of death (4.4% vs. 6.9%, p = 0.454), MACE (6.3% vs. 8.1%, p = 0.664), stent thrombosis (1.9% vs. 0.6%, p = 0.625), and repeat myocardial infarction (0.6% vs. 0.6%, р = 1,00) between groups. Conclusion. Direct stenting in patients with ST-elevation myocardial infarction and hyperglycemia is a safe and feasible technique. Direct stenting in patients with hyperglycemia undergoing percutaneous coronary intervention for ST-elevation myocardial infarction was characterised with decrease in no-reflow rate.