An angiographic evaluation of restenosis rate at a six-month follow-up of patients with ST-elevation myocardial infarction submitted to primary percutaneous coronary intervention

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Abstract

Background

Percutaneous coronary intervention (PCI) is considered to be the optimal type of revascularization in patients with ST-segment elevation myocardial infarction (STEMI). However, the long-term effectiveness of this procedure can be reduced by restenosis. This investigation was aimed at a prospective evaluation, in a group of STEMI patients of “the real world” (not involved in randomised trials), of the angiographic restenosis rate at a 6-month follow-up, and at identifying the relationship between restenosis and the patients' characteristics.

Materials and methods

Our study population consisted of 123 patients with STEMI submitted to primary PCI to then undergo stress echocardiography 3 months after PCI and an angiographic evaluation at a 6-month follow-up.

Results

a) In real life the restenosis rate is quite high (42.3%); b) no correlation was found between patients' clinical characteristics and restenosis; c) restenosis rate was higher in patients with bare metal stents than in those with drug-eluting stents (55.8% vs. 11.1%; p < 0.001); in patients with longer stents (21.6 ± 8.62 vs 18.1 ± 6.34 mm, p = 0.015) and when more than one stent was implanted. Moreover, a consistent number of patients showed restenosis though asymptomatic.

Conclusions

Our data suggest that primary PCI is associated with a high incidence of angiographic restenosis. No correlation was found between patients' clinical characteristics and restenosis. The length and the number of implanted stents seem to be associated with a more probable restenosis at six-month angiographic evaluation. Drug-eluting stent implantation seems to be associated with a lower incidence of restenosis even in STEMI patients.

Introduction

Percutaneous coronary intervention (PCI) is considered to be the optimal type of revascularization in patients with ST-segment elevation myocardial infarction (STEMI) when timely performed by skilled and experienced operators in high-volume centers [1].

However, the long-term effectiveness of this procedure in STEMI patients can be reduced by restenosis, which requires repeated target lesion revascularization (TLR) in a consistent number of patients [2], [3], [4], [5].

Routine bare metal stent (BMS) implantation in patients undergoing mechanical reperfusion therapy for STEMI has been shown to be associated, when compared with balloon angioplasty alone, with reduced rates of angiographic restenosis and subsequent need for TLR [6], [7].

Drug-eluting stents (DES) significantly reduce the risk of both restenosis and target-vessel revascularization after elective PCI, as compared with uncoated stents [8], [9], [10].

Up to now, available data on the effect of DES on restenosis in STEMI patients [11], [12], [13], [14], [15], [16], [17] has been conflicting.

Moreover, data regarding angiographic rate restenosis in the real life of STEMI patients, that is patients not involved in randomized trials with primary PCI, are limited and incomplete [18], [19], [20].

This investigation was therefore aimed at a prospective evaluation of evaluating the angiographic restenosis rate in a group of STEMI patients of “the real world scenario “submitted to PCI in a high-volume center, at a 6-month follow-up. The aim, too, was to identify the relationship between restenosis and the characteristics and procedural data of the patients.

Section snippets

Study population

From June 2003 to June 2004, 340 consecutive STEMI patients [157 (46.1%) admitted straight to our hospital and 183 (53.9%) transferred from other hospitals] were treated with PCI in the Catherization Laboratory of Clinica Medica e Cardiologia, University of Florence, which is a tertiary center, able to perform PCI 24 h round the clock, both in patients directly admitted to our hospital and in patients transferred from primary and secondary centers where PCI is not available [21]. All patients

Results

Table 1 shows the clinical characteristics, risk factors and STEMI location, as well as the Killip class of the 123 patients included in the study. Our population consists mainly of males (M/F: 110/13). Most patients (94.3%) showed a Killip class I–II. Angiographic and procedural data are depicted in Table 2. Seventy-two patients (58.5%) exhibited two and three vessel coronary diseases. Stent implantation was performed in almost all patients (99.2%) and bare metal stents were implanted in

Discussion

The main findings of this investigation are as follows: 1) in real life, the restenosis rate is quite high in patients with STEMI after treatment with primary PCI; 2) in our population, restenosis seems to be associated with type, length and number of implanted stents; 3) a consistent number of patients showed restenosis, though asymptomatic.

Conclusion

Our data suggest that primary PCI is associated with a high incidence of angiographic restenosis which was asymptomatic in 38.5% of patients, while it showed up as an acute coronary syndrome in 25.0% of the symptomatic patients.

No correlation was found between patients' clinical characteristics and restenosis. The length and the number of implanted stents seem to be associated with a more probable restenosis at six-month angiographic evaluation.

DES implantation seems to be associated with a

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