From the Department of Cardiology, Hospital De Weezenlanden, Zwolle, the
Netherlands.
Correspondence to Harry Suryapranata, MD, PhD, Department of Cardiology, Hospital De Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, Netherlands.
Background—Although the benefits of
primary angioplasty in acute myocardial infarction have been
demonstrated, several areas for improvement remain. Therefore, a
prospective randomized trial comparing primary stenting with balloon
angioplasty in patients with acute myocardial infarction was
conducted.
Methods and Results—Patients with acute myocardial infarction
were randomly assigned to undergo either primary stenting (n=112) or
balloon angioplasty (n=115). The clinical end points were death,
recurrent infarction, subsequent bypass surgery, or repeat angioplasty
of the infarct-related vessel. The overall mortality rate at 6 months
was 2%. Recurrent infarction occurred in 8 patients (7%) after
balloon angioplasty and in 1 (1%) after stenting
(P=0.036). Subsequent target-vessel
revascularization was necessary in 19 (17%) and 4
(4%) patients, respectively (P=0.0016). The cardiac
event-free survival rate in the stent group was significantly higher
than in the balloon angioplasty group (95% versus 80%;
P=0.012).
Conclusions—In selected patients with acute myocardial
infarction, primary stenting can be applied safely and effectively,
resulting in a lower incidence of recurrent infarction and a
significant reduction in the need for subsequent target-vessel
revascularization compared with balloon
angioplasty.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Randomized Comparison of Coronary Stenting With Balloon Angioplasty in Selected Patients With Acute Myocardial Infarction
Key Words: stents • myocardial infarction • angioplasty
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I. Herz, A. Assali, A. Solodky, N. Shor, T. Ben-Gal, Y. Adler, and Y. Birnbaum Coronary Stent Deployment Without Predilation in Acute Myocardial Infarction: A Feasible, Safe, and Effective Technique Angiology, November 1, 1999; 50(11): 901 - 908. [Abstract] [PDF]
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S BRENER and E J TOPOL Logic and logistics: conundrum in reperfusion treatment for acute myocardial infarction Heart, October 1, 1999; 82(4): 402 - 403. [Full Text] [PDF]
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T. J. Ryan, E. M. Antman, N. H. Brooks, R. M. Califf, L. D. Hillis, L. F. Hiratzka, E. Rapaport, B. Riegel, R. O. Russell, E. E. Smith III, et al. 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction) J. Am. Coll. Cardiol., September 1, 1999; 34(3): 890 - 911. [Full Text] [PDF]
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N. Danchin, L. Vaur, N. Genes, S. Etienne, M. Angioi, J. Ferrieres, and J.-P. Cambou Treatment of Acute Myocardial Infarction by Primary Coronary Angioplasty or Intravenous Thrombolysis in the "Real World" : One-Year Results From a Nationwide French Survey Circulation, May 25, 1999; 99(20): 2639 - 2644. [Abstract] [Full Text] [PDF]
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C. M. Gibson Primary Angioplasty Compared with Thrombolysis: New Issues in the Era of Glycoprotein IIb/IIIa Inhibition and Intracoronary Stenting Ann Intern Med, May 18, 1999; 130(10): 841 - 847. [Abstract] [Full Text] [PDF]
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P. J. Scanlon, D. P. Faxon, A.-M. Audet, B. Carabello, G. J. Dehmer, K. A. Eagle, R. D. Legako, D. F. Leon, J. A. Murray, S. E. Nissen, et al. ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1756 - 1824. [Full Text] [PDF]
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G. W. Stone, B. R. Brodie, J. J. Griffin, C. Costantini, M. C. Morice, F. G. St. Goar, P. A. Overlie, J. J. Popma, J. McDonnell, D. Jones, et al. Clinical and Angiographic Follow-Up After Primary Stenting in Acute Myocardial Infarction : The Primary Angioplasty in Myocardial Infarction (PAMI) Stent Pilot Trial Circulation, March 30, 1999; 99(12): 1548 - 1554. [Abstract] [Full Text] [PDF]
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F.-J. Neumann, R. Blasini, C. Schmitt, E. Alt, J. Dirschinger, M. Gawaz, A. Kastrati, and A. Schomig Effect of Glycoprotein IIb/IIIa Receptor Blockade on Recovery of Coronary Flow and Left Ventricular Function After the Placement of Coronary-Artery Stents in Acute Myocardial Infarction Circulation, December 15, 1998; 98(24): 2695 - 2701. [Abstract] [Full Text] [PDF]
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 Stenting vs. Angioplasty for Acute MI: A Promising Small Trial Journal Watch (General), July 10, 1998; 1998(710): 5 - 5. [Full Text]
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G. W. Stone Primary Stenting in Acute Myocardial Infarction : The Promise and the Proof Circulation, June 30, 1998; 97(25): 2482 - 2485. [Full Text] [PDF]
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