Comparison of direct stenting with conventional strategy on myocardial impairments in ST-segment elevation myocardial infarction: a cardiac magnetic resonance imaging study

Autor: Jun-Tong Zeng, Zheng Li, Jun Pu, Jianrong Xu, Bo-Zhong Shi, Hu-Wen Wang, Bing-Hua Chen, Jiancheng Xiu, Ling-Cong Kong, Heng Ge, Fuhua Yan, Dong-Aolei An, Jie He, Yining Yang, Song Ding, Fan Yang
Rok vydání: 2020
Předmět:
China
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Magnetic Resonance Imaging
Cine
Infarction
030204 cardiovascular system & hematology
Patient Readmission
Risk Assessment
Ventricular Function
Left
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Predictive Value of Tests
Recurrence
Risk Factors
Cardiac magnetic resonance imaging
Coronary Circulation
Internal medicine
medicine
Humans
ST segment
Radiology
Nuclear Medicine and imaging
Prospective Studies
Registries
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Stroke
Heart Failure
Ejection fraction
medicine.diagnostic_test
business.industry
Microcirculation
Percutaneous coronary intervention
Recovery of Function
medicine.disease
Treatment Outcome
Heart failure
Cardiology
ST Elevation Myocardial Infarction
Stents
Cardiology and Cardiovascular Medicine
business
Zdroj: The International Journal of Cardiovascular Imaging. 36:1167-1175
ISSN: 1573-0743
1569-5794
Popis: Direct stenting (DS) without pre-dilatation of the culprit lesion might improve myocardial perfusion and prognosis in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI); however, some studies report conflicting results. We investigated whether DS provides incremental myocardial benefits over conventional stenting (CS) in STEMI patients based on cardiac magnetic resonance imaging (CMR) measures. Reperfused patients who underwent CMR examinations within 1 week of STEMI onset were selected from a multicenter CMR registry of STEMI (NCT: 03768453). Patients were stratified into either a DS or CS group. Each group comprised 137 patients after 1:1 propensity score matching. Major adverse events (MACEs), including death, myocardial re-infarction, re-admission for heart failure, and stroke were noted during a median period of 44 months (interquartile range 32-58 months). DS was associated with larger (p = 0.007) and shorter (p = 0.005) stent sizes than CS. DS and CS achieved comparable angiographic TIMI-3 flow grades (p = 0.86) and myocardial blush grades (p = 0.70). There were no group differences regarding the incidence of CMR manifestations of microvascular dysfunction, including microvascular obstruction (MVO) (p = 0.89) and intramyocardial hemorrhage (p = 0.47), the extent of MVO (p = 0.21), infarction size (p = 0.83), or left ventricular ejection fraction (p = 0.57). Kaplan-Meier analysis revealed similar risks of MACEs (log rank p = 0.909), which occurred in 23.4% of DS and 26.3% of CS patients (p = 0.576). DS did not show any incremental benefits over CS on myocardial impairments as evaluated using CMR.Clinical Trial Registration: Clinicaltrials.gov, NCT: 03768453.
Databáze: OpenAIRE
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