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Short-Term Safety and Long-Term Benefits of Stent Postdilation After Primary Percutaneous Coronary Intervention: Results of a Cohort Study Publisher Pubmed



Saadat N1 ; Saadatagah S1 ; Aghajani Nargesi A2 ; Alidoosti M1 ; Poorhosseini H1 ; Amirzadegan A1 ; Lashkari R1 ; Mortazavi SH1 ; Jalali A1 ; Ghodsi S1 ; Salarifar M1
Authors
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Authors Affiliations
  1. 1. Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States

Source: Catheterization and Cardiovascular Interventions Published:2020


Abstract

Aim: Achieving the optimal apposition of coronary stents during percutaneous coronary intervention is not always feasible. The risks and benefits of stent postdilation in primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI) have remained controversial. We sought to evaluate the immediate angiographic and long-term outcomes in patients with and without stent postdilation. Methods: A cohort of patients (n = 1,224) with STEMI, treated with PPCI (n = 500 postdilated; n = 724 controls), were studied. The flow grade, the myocardial blush grade, and the frame count were considered angiographic outcomes. The clinical outcomes were major adverse cardiovascular events (MACE)—comprising cardiac death, nonfatal MI, and repeat revascularization—and the device-oriented composite endpoint (DOCE)—consisting of cardiac death, target lesion revascularization, and target vessel revascularization. Results: The flow and myocardial blush grades were not different between the two groups, and the frame count was significantly lower in the postdilation group (15.7 ± 8.4 vs. 17 ± 10.4; p <.05). The patients were followed up for 348 ± 399 days. DOCE (2.2% vs. 5.8%) and cardiac mortality (1.2% vs. 3.2%) were lower in the postdilation group. In the fully adjusted propensity score-matched analysis, postdilation was associated with decreased DOCE (HR = 0.40 [0.18–0.87], p =.021). Conclusions: Selective postdilation improved some angiographic and clinical outcomes and could not be discouraged in PPCI on patients with STEMI. © 2019 Wiley Periodicals, Inc.