Post-dilatation improves stent apposition in patients with ST-segment elevation myocardial infarction receiving primary percutaneous intervention: A multicenter, randomized controlled trial / 世界急诊医学杂志（英文）

BACKGROUND@# Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction (STEMI). This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention (pPCI) for acute STEMI.@*METHODS@# The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation. Patients were randomly assigned to control group (n=20) or post-dilatation group (n=21) in which a non-compliant balloon was inflated to >16 atm pressure. Strut apposition and coverage were evaluated by optical coherence tomography (OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up. The primary endpoint was rate of incomplete strut apposition (ISA) at 7 months after pPCI.@*RESULTS@# There were similar baseline characteristics except for stent length (21.9 [SD 6.5] mm vs. 26.0 [SD 5.8] mm, respectively, P=0.03). In post-dilatation vs. control group, ISA rate was lower (2.5% vs. 4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate (95.2% vs. 95.0%, P>0.05) or corrected TIMI frame counts (22.6±9.4 vs. 22.0±9.7, P>0.05); and at 7-month follow-up (0.7% vs. 1.8%, P<0.0001), the primary study endpoint, with similar strut coverage (98.5% vs. 98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events (MACE).@*CONCLUSION@# In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate. Larger and longer term studies are warranted to further assess safety (ClinicalTrials.gov identifi er: NCT02121223).

Low major adverse cardiac event rates following bioresorbable vascular scaffold implantation: Impact of implantation technique on treatment outcomes

Background and objective Studies conducted across the world have reported that the rates of major adverse cardiac events (MACE) following the use of bioresorbable vascular scaffolds (BVS) are comparable to that noted with traditional drug eluting stents (DES). However, there is limited data on the immediate and medium-term clinical outcomes following the use of the Absorb BVS (Abbott Vascular, Santa Clara, SA) in the Indian context. This study was conducted to determine real-world evidence on the immediate and medium-term clinical outcomes in all patients undergoing percutaneous coronary intervention (PCI) with the Absorb BVS. Methods Data of all patients who were treated with Absorb BVS at our center were evaluated. Between December 2012 and October 2016, 142 patients underwent PCI with BVS. The MACE rates during hospitalization, at 30 days, 3 months, 6 months after PCI, and every 6 months thereafter were the primary endpoints evaluated with median follow up of 13 months. Results Mean age of the study participants was 53.7 ± 11.8 years. Intravascular ultrasound imaging was performed in 15.34% of patients. Predilatation and postdilatation were performed in 81.8% and 84.6% of scaffolds, respectively. There were no episodes of MACE during hospitalization. However, 1 BVS-related MACE was observed at the 1-month (0.7%) as well as at the ≥12 month (0.8%) follow up visits. At the 6- and 12-month follow up visits, 2 (1.5%) and 3 (2.5%) non-BVS-related MACEs, respectively, were recorded. Conclusion The use of Absorb BVS in this real-world experience was associated with very good immediate and medium-term clinical outcomes.

Effect of post-dilatation on in-stent restenosis of long lesion coronary heart disease patients received percutaneous coronary artery interventional therap / 中国综合临床

Objective To evaluate the effect of post-dilatation on in-stent restenosis of long lesion coronary heart disease patients received percutaneous coronary artery interventional(PCI) therapy.Methods A total of 92 cases coronary heart disease patients in Gaoxin Hospital of Xi'an from January 2008 to January 2014 were randomly divided into the post-dilatation deployment group (n =47) and control group (n =45).The postdilatation deployment group were given stent after expansion after conventional coronary stenting, while the control didn't use after expansion.The clinical features and profile of drug-eluting stent(DES) implantation and stent restenosis(examined by 256-shce spiral computed tomography coronary angiography(MSCTCA) and major adverse cardiac events(MACE) within hospitalization and 12 months were observed.Results Stent restenosis occurred in 1 patient(2.1％) in the post-dilatatioh deployment group and 8 patients(17.7％) in the control group in 12 months examed by MSCTCA,the difference was significant(P=0.03).MACE occurred in 3 patients (6.4％) in the post-dilatation deployment group and 11 patients (24.4％) in the control group, the difference was significant (P =0.03).Conclusion Routine post-dilatation tactics is effective for long lesion coronary heart disease patients with PCI.It is associated with lower coronary restenosis and lower MACE.