Clinical and angiographic follow-up after primary stenting in acute myocardial infarction : The Primary Angioplasty in Myocardial Infarction (PAMI) stent pilot trial

• Published in: Circulation (New York, N.Y.) Vol. 99; no. 12; pp. 1548 - 1554
• Main Authors: STONE, G. W, BRODIE, B. R, O'NEILL, W. W, GRINES, C. L, GRIFFIN, J. J, COSTANTINI, C, MORICE, M. C, GOAR, F. G. S, OVERLIE, P. A, POPMA, J. J, MCDONNELL, J, JONES, D
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 30-03-1999; American Heart Association, Inc
• Subjects: Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Coronary Angiography; Coronary heart disease; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - therapy; Pilot Projects; Prospective Studies; Recurrence; Regression Analysis; Stents; Human; Endoprosthesis; Prognosis; Radiodiagnosis; Angiography; Infarct; Acute; Coronary artery; Instrumentation therapy; Cardiovascular disease; Instrumental dilatation; Coronary heart disease; Myocardial disease; Survival; Restenosis; Treatment; Follow up study; Primary; Myocardium
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.99.12.1548

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 approximately 20% of patients during this time period. Routine (primary) stent implantation after PTCA has the potential to further improve late outcomes.
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.
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.