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Original Article
Volume 341:1949-1956 December 23, 1999 Number 26
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Coronary Angioplasty with or without Stent Implantation for Acute Myocardial Infarction
Cindy L. Grines, M.D., David A. Cox, M.D., Gregg W. Stone, M.D., Eulogio Garcia, M.D., Luiz A. Mattos, M.D., Alessandro Giambartolomei, M.D., Bruce R. Brodie, M.D., Olivier Madonna, M.D., Marcel Eijgelshoven, Ph.D., Alexandra J. Lansky, M.D., William W. O'Neill, M.D., Marie-Claude Morice, M.D., for The Stent Primary Angioplasty in Myocardial Infarction Study Group

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ABSTRACT

Background Coronary-stent implantation is frequently performed for treatment of acute myocardial infarction. However, few studies have compared stent implantation with primary angioplasty alone.

Methods We designed a multicenter study to compare primary angioplasty with angioplasty accompanied by implantation of a heparin-coated Palmaz–Schatz stent. Patients with acute myocardial infarction underwent emergency catheterization and angioplasty. Those with vessels suitable for stenting were randomly assigned to undergo angioplasty with stenting (452 patients) or angioplasty alone (448 patients).

Results The mean (±SD) minimal luminal diameter was larger after stenting than after angioplasty alone (2.56±0.44 mm vs. 2.12±0.45 mm, P<0.001), although fewer patients assigned to stenting had grade 3 blood flow (according to the classification of the Thrombolysis in Myocardial Infarction trial) (89.4 percent, vs. 92.7 percent in the angioplasty group; P=0.10). After six months, fewer patients in the stent group than in the angioplasty group had angina (11.3 percent vs. 16.9 percent, P=0.02) or needed target-vessel revascularization because of ischemia (7.7 percent vs. 17.0 percent, P<0.001). In addition, the combined primary end point of death, reinfarction, disabling stroke, or target-vessel revascularization because of ischemia occurred in fewer patients in the stent group than in the angioplasty group (12.6 percent vs. 20.1 percent, P<0.01). The decrease in the combined end point was due entirely to the decreased need for target-vessel revascularization. The six-month mortality rates were 4.2 percent in the stent group and 2.7 percent in the angioplasty group (P=0.27). Angiographic follow-up at 6.5 months demonstrated a lower incidence of restenosis in the stent group than in the angioplasty group (20.3 percent vs. 33.5 percent, P<0.001).

Conclusions In patients with acute myocardial infarction, routine implantation of a stent has clinical benefits beyond those of primary coronary angioplasty alone.


Source Information

From the Division of Cardiology, William Beaumont Hospital, Royal Oak, Mich. (C.L.G., W.W.O.); Mid Carolina Cardiology, Charlotte, N.C. (D.A.C.); Washington Hospital Center, Washington, D.C. (G.W.S., A.J.L.); Hospital Gregorio Maranon, Madrid (E.G.); Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil (L.A.M.); St. Joseph's Hospital, Syracuse, N.Y. (A.G.); LeBauer Health Care, Greensboro, N.C. (B.R.B.); Cordis, Johnson & Johnson, Paris (O.M.); Cardialysis, Rotterdam, the Netherlands (M.E.); and Institut Cardiovasculaire Paris Sud, Antony, France (M.-C.M.).

Address reprint requests to Dr. Grines at the Cardiac Catheterization Laboratories, William Beaumont Hospital, 3601 W. Thirteen Mile Rd., Royal Oak, MI 48073-6769.

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Related Letters:

Coronary-Artery Stenting in Acute Myocardial Infarction
Hoffman R. M., Allen L., Baumel M. J., Alfonso F., Grines C. L.
Extract | Full Text  
N Engl J Med 2000; 342:1447-1448, May 11, 2000. Correspondence

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