The impact of multiple stent implantation in the infarct-related artery on one-year clinical outcomes of patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Data from the Polish NRDES Registry

Abstract

A b s t r a c t Background and aim:We sought to evaluate the impact of multiple stent implantation in the infarct-related artery (IRA) on one-year clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods and results:Data on 1741 consecutive patients with STEMI, who underwent immediate PCI with implantation of ≥ 1 stent, enrolled the National Registry of Drug Eluting Stents (NRDES) were assessed. Patients were stratified based on the number of implanted stents in IRA: 1 vs. ≥ 2 stents. At the discretion of operators, ≥ 2 stents in IRA were implanted in 247 (14.2%) patients. The remaining 1494 patients were treated with a single stent. Patients treated with multiple stents were less likely to achieve Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow after primary PCI. Overall mortality at one year was 8.3% in the single stent group and 10.3% in the ≥ 2 stents group (p = 0.37; adjusted for propensity score p = 0.13). After propensity score matching, patients treated with ≥ 2 stents were at higher risk of definite or probable stent thrombosis and urgent revascularisation at one year. Conclusions:In patients with STEMI undergoing primary PCI, a need for implantation of ≥ 2 stents in IRA carries an increased risk of stent thrombosis and urgent revascularisation at one year.

The risk for subsequent coronary interventions in a local Polish population

“…Survival curves depending on the number of critically narrowed vessels (one-vessel disease as a reference) sults with findings of other Polish registries. DES was superior to BMS in impact on 1-year mortality in the STEMI group [12], but on the other hand the implantation of 2 DES was the cause of higher mortality and restenosis as opposed to implantation of 2 BMS [13].…”

Current perspectives on the role of bioresorbable scaffolds in the management of coronary artery disease

“…Second, thrombogenicity and local inflammation might be induced by the breakdown products and/or the extracellular matrix replacing the strut void [12,[32][33][34]. Third, similarly to metallic DES, incomplete lesion coverage, underexpansion, and strut malapposition were shown to be linked to the Absorb thrombosis [35][36][37]. However, these might be expected more frequently with the Absorb due to its physical properties and a higher possibility of acute recoil and strut fracture as compared to metallic DES.…”