Original title: The Independent Value of a Direct Stenting Strategy on Early and Late Clinical Outcomes in Patients Undergoing Elective Percutaneous Coronary Intervention. Reference: Gabriel L. Sardi et al. Catheterization and Cardiovascular Interventions 81:949–956 (2013).
The use of direct stenting (DS) without pre-stenting dilation has proven to be a safe strategy, especially with the advances that have been achieved in the profile of the new generation devices. In theory, the incidence of peri-procedural myocardial injury and no-reflow phenomenon would be lower given the slightest chance of distal embolization and wall damage compared to pre systematic dilation. In this study, the decision regarding what strategy to use was at the discretion of the operator, so that propensity score was used to match the differences in baseline characteristics of both groups, which left 444 patients in each branch for the final analysis.
The primary endpoint of the analysis was the extent of myocardial injury peri-procedural according to the elevation of CK-MB. The indicative variables of the use of resources such as procedure time, contrast volume and post dilatation balloons used were significantly higher in pre branch dilatation. The peri-procedural myocardial injury was virtually identical in both groups, (5.3% versus PD SD 5.4%, p = 0.91), as was the incidence of death, myocardial infarction, revascularization or a combination of all (MACE).
Conclusion:
In the context of elective angioplasty, a direct stenting strategy reduces procedure time and resource utilization but has no demonstrable clinical benefit at one year.
Editorial comment:
The mere fact of diminishing resources, and therefore costs, seems to be reason enough to use direct stenting. Perhaps the most important aspect is correctly judging the injury before starting and choosing a strategy according to the anatomical complexity. These results should not be extended to studying patients with acute coronary syndrome.
SOLACI
