Association of Strategy of Direct Stenting of Infarct-Related Artery with Reduction of Mortality in Woman with ST-Elevation Myocardial Infarction

Aim of this study was to evaluate the impact of direct stenting (DS) strategy on the results of treatment of female patients with STelevation myocardial infarction (STEMI) undergoing percutaneous coronary interventions (PCIs). Materials and methods. Among 1297 patients with STEMI admitted to the coronary care unit and subjected to PCIs from 2006 to 2015 there were 330 women (25.4 %). Data from 161 women (48.8 %) who underwent DS were compared with those from 169 women who underwent indirect stenting (IS). Among patients of IS group in 148 (87.6 %) stenting was performed after predilation, in 7 (4.1 %) after manual thrombus aspiration, and in 14 (8.3 %) after combination of predilation and thrombus aspiration. Results. The rate of angiographic success was higher in the DS group (97.5 vs. 87.6 %, р<0.001). Rates of deaths (4.3 vs. 11.8 %; p=0.013), major adverse cardiac events (MACE)
(4.3 vs. 13 %; p=0.005), and no-reflow (1.9 % vs. 11.2 %; p=0.013) were significantly lower in the DS group. There were no differences in rates of recurrent myocardial infarction and access site complications. Following propensity score matching, each group contained 78 patients. Rates of MACE (2.6 vs. 14.1 %; p=0.009) and deaths (2.6 vs. 12.8 %; p=0.016) remained significantly lower in the DS group. After multivariate adjustment, DS strategy was independently associated with lower mortality (odds ratio [OR] 0.29; 95 % confidence interval [CI] 0.09–0.97; p=0.04) and MACE (OR=0.28; 95 %CI 0.09–0.087; p=0.03). Conclusion. DS strategy in STEMI female patients turned out to be safe and effective technique.

1. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2018;39(2):119–77. DOI: 10.1093/eurheartj/ehx393

2. Kuznetsov V. A., Yaroslavskaya E. I., Pushkarev G. S., Zyryanov I. P., Bessonov I. S., Gorbatenko E. A. et al. Interrelation of transcutaneous coronary interventions for acute forms of coronary heart disease and mortality parameters in tyumen region inhabitants. Russian Journal of Cardiology. 2014;19(6):42–6. DOI: 10.15829/1560-4071-2014-6-42-46

3. Аlekyan B.G., Grigor’yan А.M., Staferov А.V. X-ray endovascular diagnostics and treatment of heart and vascular diseases in the Russian Federation –2016 year. -M.: LA Graphics; 2016. –220p. ISBN 978-5-4465-1503-5

4. Lawesson SS, Alfredsson J, Fredrikson M, Swahn E. A gender perspective on short- and long term mortality in ST-elevation myocardial infarction – A report from the SWEDEHEART register. International Journal of Cardiology. 2013;168(2):1041–7. DOI: 10.1016/j.ijcard.2012.10.028

5. Kytö V, Sipilä J, Rautava P. Gender and In-hospital Mortality of ST-Segment Elevation Myocardial Infarction (from a Multihospital Nationwide Registry Study of 31,689 Patients). The American Journal of Cardiology. 2015;115(3):303–6. DOI: 10.1016/j.amjcard.2014.11.001

6. Dziewierz A, Siudak Z, Rakowski T, Kleczyński P, Zasada W, Dubiel JS et al. Impact of direct stenting on outcome of patients with ST-elevation myocardial infarction transferred for primary percutaneous coronary intervention (from the EUROTRANSFER registry): Direct Stenting in STEMI. Catheterization and Cardiovascular Interventions. 2014;84(6):925–31. DOI: 10.1002/ccd.25266

7. McCormick LM, Brown AJ, Ring LS, Gajendragadkar PR, Dockrill SJ, Hansom SP et al. Direct stenting is an independent predictor of improved survival in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction. European Heart Journal: Acute Cardiovascular Care. 2014;3(4):340–6. DOI: 10.1177/2048872614530864

8. Bessonov I.S., Kuznetsov V.A., Zyrianov I.P., Sapozhnikov S.S., Potolinskaya Y.V., Zyrianova T.I. Comparison of Direct Stenting Versus Stending After Pre-Dilation in ST-Elevation Myocardial Infarction. Kardiologiia. 2017;57(11):5–10.DOI: 10.18087/cardio.2017.11.10048

9. Li C, Zhang B, Li M, Liu J, Wang L, Liu Y et al. Comparing Direct Stenting With Conventional Stenting in Patients With Acute Coronary Syndromes: A Meta-Analysis of 12 Clinical Trials. Angiology. 2016;67(4):317–25. DOI: 10.1177/0003319715585662

10. Azzalini L, Millán X, Ly HQ, L’Allier PL, Jolicoeur EM. Direct Stenting Versus Pre-Dilation in ST-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis: Direct Stenting Versus Pre-Dilation in ST-Elevation Myocardial Infarction. Journal of Interventional Cardiology. 2015;28(2):119–31. DOI: 10.1111/joic.12190

11. Jaffe R, Charron T, Puley G, Dick A, Strauss BH. Microvascular Obstruction and the No-Reflow Phenomenon After Percutaneous Coronary Intervention. Circulation. 2008;117(24):3152–6. DOI: 10.1161/CIRCULATIONAHA.107.742312

12. D’Ascenzo F, Cavallero E, Biondi-Zoccai G, Moretti C, Omedè P, Bollati M et al. Use and Misuse of Multivariable Approaches in Interventional Cardiology Studies on Drug-Eluting Stents: A Systematic Review: MULTIVARIABLE APPROACH IN DRUGELUTING STENT STUDIES. Journal of Interventional Cardiology. 2012;25(6):611–21. DOI: 10.1111/j.1540-8183.2012.00753.x

13. Bessonov I, Zyryanov I, Sapozhnikov S, Kuznetsov V. Direct Stenting Strategy is Associated with Improved Outcomes in Patients with Totally Occluded Culprit Arteries Undergoing Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction. Journal of the American College of Cardiology. 2017;70(18):B1. DOI: 10.1016/j.jacc.2017.09.039

14. Finnegan JR, Meischke H, Zapka JG, Leviton L, Meshack A, Benjamin-Garner R et al. Patient Delay in Seeking Care for Heart Attack Symptoms: Findings from Focus Groups Conducted in Five U.S. Regions. Preventive Medicine. 2000;31(3):205–13. DOI: 10.1006/pmed.2000.0702

15. Lawesson SS, Isaksson R-M, Thylén I, Ericsson M, Ängerud K, Swahn E. Gender differences in symptom presentation of ST-elevation myocardial infarction – An observational multicenter survey study. International Journal of Cardiology. 2018;264:7–11. DOI: 10.1016/j.ijcard.2018.03.084

16. Cenko E, Yoon J, Kedev S, Stankovic G, Vasiljevic Z, Krljanac G et al. Sex Differences in Outcomes After STEMI: Effect Modification by Treatment Strategy and Age. JAMA Internal Medicine. 2018;178(5):632. DOI: 10.1001/jamainternmed.2018.0514

17. Sun R, Sun L, Fu Y, Liu H, Xu M, Ren X et al. Culprit plaque characteristics in women vs men with a first ST-segment elevation myocardial infarction: In vivo optical coherence tomography insights. Clinical Cardiology. 2017;40(12):1285–90. DOI: 10.1002/clc.22825

18. Valgimigli M, Campo G, Malagutti P, Anselmi M, Bolognese L, Ribichini F et al. Persistent Coronary No Flow After Wire Insertion Is an Early and Readily Available Mortality Risk Factor Despite Successful Mechanical Intervention in Acute Myocardial Infarction. JACC: Cardiovascular Interventions. 2011;4(1):51–62. DOI: 10.1016/j.jcin.2010.09.016