Original title: Self-Expanding Versus Balloon-Expandable Stents in Acute Myocardial Infarction: Results From the APPOSITION II Study Reference: Robert-Jan van Geuns et al. J Am Coll Cardiol Intv 2012;5:1209–19

Acute myocardial infarction is associated with vasoconstriction and thrombus occlusion. Resolution of these two points during the first hours after primary angioplasty can lead to poor extension and poor positioning of the stent implanted with the probable risk of thrombosis and restenosis. 

On the other hand, aggressive implantation could cause distal embolization. This study tested the hypothesis that self-expanding stents are more effective than balloon-expandable stents to reduce poor positioning after primary angioplasty. We randomized 80 patients with ST elevation acute myocardial infarction (STEMI) who were receiving primary angioplasty with a self-expandable stent (STENTYS, Paris, France) or a balloon-expandable stent (Vision, Abbott Vascular, Santa Clara, California, or Driver, Medtronic, Minneapolis, Minnesota). 

The primary endpoint was the proportion of the struts poor positioning after 3 days of implantation using optical coherence tomography (OCT). The secondary endpoint was major cardiac events such as cardiac death, recurrent infarction or emergency bypass surgery. After 3 days of implantation, the self-expanding stents had a lower percentage of poor strut positioning compared with balloon-expandable (0.58% versus 5.46%, respectively, P <0.001). The major cardiac events at 6 months were not significantly different between groups.

Conclusion 

Self-expanding stents had a lower incidence of poor strut positioning using OCT than balloon-expandable stents after primary angioplasty.

Editorial Comment:

This study lacks sufficient power to show the clinical differences between the two types of stent, however it does show the feasibility and safety of self-expanding stents that have already been tested at bifurcations. A particularly striking feature is the lack of data on the degree of TIMI 3 and Blush post implant. 

Courtesy of Dr. Gustavo Hidalgo.
Fellowship of Interventional Cardiology.
Fundación Favaloro.

Dr. Gustavo Hidalgo para SOLACI.ORG