(Circulation. 1999;99:1548-1554.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Clinical and Angiographic Follow-Up After Primary Stenting in Acute Myocardial Infarction
The Primary Angioplasty in Myocardial Infarction (PAMI) Stent Pilot Trial
From the Washington Hospital Center, Washington, DC (G.W.S.); Moses Cone Hospital, Greensboro, NC (B.R.B.); Virginia Beach General Hospital, Virginia Beach, Va (J.J.G.); Hospital Santa Case de Misericordia, Curitiba, Brazil (C.C.); Institut Cardiovasculaire Paris Sud, Antony, France (M.C.M.); The Cardiovascular Institute, El Camino Hospital, Mountain View, Calif (F.G.S.G., J.M.); St. Mary of the Plains, Lubbock, Tex (P.A.O.); Brigham and Women's Hospital, Boston, Mass (J.J.P.); and the Division of Cardiology, William Beaumont Hospital, Royal Oak, Mich (D.J., W.W.O, C.L.G.).
Background—Restenosis
has been reported in as many as 50% of patients within 6 months after
PTCA in acute myocardial infarction (AMI), which necessitates repeat
target-vessel revascularization (TVR) in 
20% of
patients during this time period. Routine (primary) stent implantation
after PTCA has the potential to further improve late outcomes.
Methods and Results—Primary stenting was performed as part of a prospective study in 236 consecutive patients without contraindications who presented with AMI of <12 hours' duration at 9 international centers. A mean of 1.4±0.7 stents were implanted per patient (97% Palmaz-Schatz) at 17.3±2.4 atm. During a clinical follow-up period of 7.4±2.6 months, death occurred in 4 patients (1.7%), reinfarction occurred in 5 patients (2.1%), and TVR was required in 26 patients (11.1%). By Cox regression analysis, small reference-vessel diameter and the number of stents implanted were the strongest determinants of TVR. Angiographic restenosis occurred in 27.5% of lesions. By multiple logistic regression analysis, the number of stents implanted and the absence of thrombus on the baseline angiogram were independent determinants of binary restenosis.
Conclusions—A strategy of routine stent implantation during mechanical reperfusion of AMI is safe and is associated with favorable event-free survival and low rates of restenosis compared with primary PTCA alone.
Key Words: angioplasty • restenosis • myocardial infarction • revascularization • stents
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