Сравнение прямого стентирования и стентирования с предилатацией у пациентов с острым инфарктом миокарда с подъемом сегмента ST

Aim. To study was to assess in-hospital outcomes of direct coronary stenting (DS) compared with stenting after predilation (PD) in patients with ST-elevation myocardial infarction (STEMI). Material and methods. Data were collected from all patients (n=1103) with STEMI subjected to primary PCI in Tyumen cardiology center from 2006 to 2014. The clinical and angiographic characteristics, in-hospital outcomes, as well as predictors of no-reflow phenomenon were analyzed. The composite of in-hospital death, myocardial infarction (MI) and stent thrombosis were defined as major adverse cardiac events (MACE). Results. Altogether 563 patients (51%) underwent DS, and in 540 (49%) stents were implanted after PD. Patients in DS group compared with those in PD group were younger (57.9±10.9 vs 60±11.5 years; p=0.001), less often had chronic kidney disease (5.2 vs 8.4%; р=0.034), more often recieved prehospital thrombolysis (25 vs 11.9%; p<0.001). Rates of diabetes mellitus (16.1 vs 17.5%; р=0.522), and history of MI (15.5 vs 18.7%; р=0.162), time from onset symptoms to diagnosis (120 [73; 205] min и 120 [65.5; 239.5] min; р=0.289) were comparable between groups. Patients of DS group less often had occluded culprit arteries (47.4 vs 84.3%; p<0.001) and multivessel coronary artery involvement (23.8 vs 34.4%; p<0.001). There were no differences in rates of stent thrombosis (1.2 vs 2.8%; p=0.068) and repeat MI (1.4 vs 1.9%; p=0.572). Rates of angiographic success (95.7 vs 90%; р<0.001), death (2.5 vs 5.4%; p=0.013), MACE (6.7 vs 11.3%; p=0.008), as well as no-reflow (2.2 vs 7.4%; p<0.001) were significantly lower in the DS group. After multivariate adjustment, PD was associated with no-reflow [odds ratio 3.39; 95% confidence interval 1.83-6.28; p<0.001]. Conclusion. DS in STEMI is safe and effective and should be used in all cases when it is possible. PD is an independent predictor of no-reflow phenomen on during PCI.

инфаркт миокарда, прямое стентирование, первичные чрескожные коронарные вмешательства, myocardial infarction, direct stenting, primary percutaneous coronary interventions

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