Direct stenting compared to balloon predilation in drug‐eluting stents

Abbott, J. Dawn; Earl, Thomas; Vlachos, Helen; Selzer, Faith; Vaidya, Kedarnath A.; Romero, Alicia; Kip, Kevin E.; Williams, David O.

doi:10.1002/ccd.22914

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Although one randomized and two post‐hoc studies demonstrated improvement in outcome with direct DES, others revealed similarity between the two strategies . However, these later studies had insufficient power to draw a firm conclusion on clinical outcomes, particularly given the expected low‐to‐modest treatment effect and the low event rates of simple lesions.…”

Section: Discussionsupporting

confidence: 87%

Does direct stenting with drug‐eluting stents improve outcome? A meta‐analysis of 10,900 patients

Magalhães

Minha

Lhermusier

et al. 2016

Cathet Cardio Intervent

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Section: Discussionsupporting

confidence: 87%

Does direct stenting with drug‐eluting stents improve outcome? A meta‐analysis of 10,900 patients

Magalhães

Minha

Lhermusier

et al. 2016

Cathet Cardio Intervent

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“…The findings from this analysis are in keeping with our data from the DEScover registry comparing DS with predilation in a contemporary population treated exclusively with DES; in that significant differences in hard clinical outcomes were not observed . The current study is additive as it provides biomarker data to allow a more accurate determination of peri‐procedural MI and expands the results to a population of patients treated with IVUS guidance.…”

supporting

confidence: 81%

Direct Stenting: Soft endpoints are enough

Earl

Abbott

2013

Cathet Cardio Intervent

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Direct stenting (DS), as compared to predilation, has been shown to be both safe and effective in the treatment of appropriately selected coronary artery stenoses [1]. Reproducible benefits of DS include lower procedural costs, shorter procedural and fluoroscopy times, and less contrast use. Biologically, DS has the potential advantage of inducing less vascular injury which may decrease peri-procedural myonecrosis and the injury response that leads to restenosis. Supporting this theory, a small randomized study showed that DS is associated with reduced microcirculatory dysfunction as determined by the index of microcirculatory resistance, compared to a strategy of pre-dilation [2]. A large metaanalysis by Piscione et al. [3], including 24 randomized trials comparing DS with conventional predilation, demonstrated a statistically significant reduction in the composite of death or myocardial infarction (MI) (primarily driven by a reduction in peri-procedural MI) at sixmonth follow-up with DS (3.95% vs. 5.10%, OR ¼ 0.76, (95% CI 0.60 to 0.96) P ¼ 0.02) without differences in the need for target-vessel revascularization. Questions remain, however, whether there is an independent and consistent benefit to DS compared to predilation on peri-procedural MI and if DS is associated with a lower risk of adverse clinical events in patients treated with drug eluting stents (DES).In this issue of the journal, Sardi et al.[4] have further evaluated a DS strategy in relation to clinical outcomes. The present analysis includes 444 patients undergoing elective PCI with DS at Washington Hospital Center between 2000 and 2010, and 444 propensity-matched patients treated with conventional predilation during the same time period. All procedural strategies were at the discretion of the operator. Routine CK-MB measurements were obtained at 6 and 24 hr in all patients. Notably, intravascular ultrasound (IVUS) was employed during the index PCI procedure in over 60% of patients in both arms. As expected, based on the study design, baseline characteristics were similar between the two groups. Lesion-based angiographic characteristics were also similar, although variables such as culprit artery calcium burden, presence of bifurcation lesions, lesion length, or reference vessel diameter were not reported. Angiographic and clinical procedural success rates were high and similar. The majority of patients were treated with DES, approximately half of whom were treated with a second-generation DES. Procedure length was significantly shorter and contrast amount significantly less in patients treated with a DS strategy. No difference in the primary end-point of peri-procedural MI was observed between patients treated with a DS or predilation strategy. Similarly, rates of major adverse cardiac events, target lesion revascularization, and definite stent thrombosis were similar among the two groups.The findings from this analysis are in keeping with our data from the DEScover registry comparing DS with predilation in a contemporary population treated exc...

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“…39,40 However, other studies have shown divergent findings such as DS could possibly reduce angiographic restenosis and TVR. [41][42][43] More randomized trials comparing CS versus DS in patients with ACS having drug-eluting stents are warranted.…”

Section: Discussionmentioning

confidence: 99%

Comparing Direct Stenting With Conventional Stenting in Patients With Acute Coronary Syndromes

Zhang

et al. 2015

Angiology

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Our aim was to compare direct stenting (DS) with conventional stenting (CS) in patients with acute coronary syndrome (ACS). We searched PubMed, EMBASE, and ISI web of science for eligible studies. Primary end point was major adverse cardiac events (MACEs) in short term. Secondary end points were 1-year mortality and after-procedural no-reflow phenomenon. Twelve trials in 8998 patients were included. The odds ratios (ORs) were pooled using the Mantel-Haenszel fixed effect model. Short-term MACEs were significantly reduced in the DS arm in contrast to the CS (5.00% vs 8.08%, DS vs CS, respectively, OR [95% confidence interval] = 0.61 [0.46-0.80], P = .0004). One-year mortality and after-procedural no-reflow phenomenon were significantly lower in the DS group. No heterogeneity was observed through I(2) test (Phet = .81, .89, and .77 for each end point, respectively). This meta-analysis demonstrated that in selected patients with ACS, DS is not only safe and feasible but also reduces short-term and 1-year mortality as well as the occurrence of after-procedural no-reflow phenomenon.

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Direct stenting compared to balloon predilation in drug‐eluting stents

Abstract: DS with DES is commonly performed in clinical practice and results in similar long-term outcomes as predilation.

Cited by 6 publications

References 17 publications

Does direct stenting with drug‐eluting stents improve outcome? A meta‐analysis of 10,900 patients

Does direct stenting with drug‐eluting stents improve outcome? A meta‐analysis of 10,900 patients

Direct Stenting: Soft endpoints are enough

Comparing Direct Stenting With Conventional Stenting in Patients With Acute Coronary Syndromes

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