The independent value of a direct stenting strategy on early and late clinical outcomes in patients undergoing elective percutaneous coronary intervention

Sardi, Gabriel; Laynez-Carnicero, Ana; Torguson, Rebecca; Zhang, Xue; Suddath, William O.; Kent, Kenneth M.; Satler, Lowell F.; Pichard, Augusto D.; Lindsay, Joseph; Waksman, Ron

doi:10.1002/ccd.24581

Cathet Cardio Intervent

2013

DOI: 10.1002/ccd.24581

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The independent value of a direct stenting strategy on early and late clinical outcomes in patients undergoing elective percutaneous coronary intervention

Gabriel Sardi

Ana Laynez-Carnicero

Rebecca Torguson

et al.

Abstract: During elective PCI, DS decreases overall procedure time and resource utilization, but fails to reveal an independent clinical advantage as there is no demonstrable benefit in regard to the incidence of PPMI, restenosis, or overall clinical outcomes up to 1-year of follow-up.

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“…In this issue of the journal, Sardi et al 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.…”

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confidence: 99%

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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confidence: 99%

Direct Stenting: Soft endpoints are enough

Earl

Abbott

2013

Cathet Cardio Intervent

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The independent value of a direct stenting strategy on early and late clinical outcomes in patients undergoing elective percutaneous coronary intervention

Abstract: During elective PCI, DS decreases overall procedure time and resource utilization, but fails to reveal an independent clinical advantage as there is no demonstrable benefit in regard to the incidence of PPMI, restenosis, or overall clinical outcomes up to 1-year of follow-up.

Cited by 1 publication

References 36 publications

Direct Stenting: Soft endpoints are enough

Direct Stenting: Soft endpoints are enough

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