Coronary artery diseaseComparison of Direct Stenting With Conventional Stent Implantation in Acute Myocardial Infarction
Section snippets
Methods
HORIZONS-AMI was a prospective, open-label, multicenter, controlled trial in patients with STEMI who underwent a primary PCI management strategy, incorporating 2 factorial randomized phases to allow comparison of the direct thrombin inhibitor bivalirudin alone to heparin plus a glycoprotein IIb/IIIa inhibitor and of paclitaxel-eluting stents to BMS.10, 11
The clinical eligibility criteria for the HORIZONS-AMI trial have been previously described.10, 11 In brief, consecutive patients aged ≥18
Results
From March 25, 2005, to May 7, 2007, 3,602 patients at 123 centers in 11 countries with STEMI who underwent primary PCI were randomized to heparin plus glycoprotein IIb/IIIa inhibitors (n = 1,802) or bivalirudin alone (n = 1,800). PCI was subsequently performed in 3,345 patients (92.9%), including 3,226 patients (96.4%) in whom stenting was attempted. Direct stenting of a single de novo native coronary lesion was attempted in 698 patients (27.6%) and conventional stenting in 1,830 patients
Discussion
The present analysis from the large-scale, international HORIZONS-AMI trial suggests that direct stenting in eligible lesions in patients with STEMI may result in improved TIMI flow, ST-segment resolution, and survival, thereby confirming and extending the results of previous smaller studies.
Previous studies in modest numbers of patients have suggested that direct stenting in STEMI is feasible and may result in less distal embolization with reduced microcirculatory dysfunction and no-reflow.
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Direct Stenting in ST Segment Elevation Myocardial Infarction: Are We There Yet?
2022, Cardiovascular Revascularization MedicineVery Long-Term Clinical Outcomes After Direct Stenting in Patients Presenting With ST-Segment Elevation Myocardial Infarction
2022, Cardiovascular Revascularization MedicineCitation Excerpt :3) Stenting technique had no relevant impact on clinical outcomes in patients with large thrombus burden. Several studies suggested direct stenting as a feasible and safe technique [1–5,7,8,14–26], especially in patients with acute myocardial infarction, often associated with a soft plaque rupture [27], not demanding aggressive lesion predilation to facilitate stent expansion. DS compared with CS was reported to improve myocardial perfusion with a concomitant reduction in procedural costs, contrast used, radiation exposure time, and procedural duration [20,23–25,28].
Effects of Peripheral Arterial Disease Interventions on Survival: A Propensity-Score Matched Analysis Using VQI Data
2022, Annals of Vascular SurgeryCitation Excerpt :It appears there maybe. Primary stenting during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), as opposed to initial POBA followed by delayed stenting, has produced superior outcomes.21-29 Distal embolization is a common complication after PCI particularly in the setting of acute coronary syndrome or vein graft interventions.
Integrated Stent Delivery System: A Next Generation of Stent Delivery and Drug-Eluting Stent
2020, Cardiovascular Revascularization MedicineCitation Excerpt :In IDS trials, ACS patients experienced device and strategy success (93% and 79%, respectively). This is a potentially important finding given the HORIZONS AMI study demonstrated direct stenting to be associated with lower rates of all-cause death compared with conventional pre-dilatation stenting (1.6% vs. 3.8%, p = 0.01) and stroke (0.3% vs. 1.1%, p = 0.049) at 1-year [27]. The postulated mechanism of these improved outcomes is reduced distal embolization, microcirculatory dysfunction and slow or no-reflow by avoiding pre-dilatation.
Prevention of coronary microvascular obstruction by addressing distal embolization
2018, Coronary Microvascular Obstruction in Acute Myocardial Infarction: From Mechanisms to TreatmentManagement of high thrombus burden in primary PCI
2017, Annales de Cardiologie et d'Angeiologie