PMID- 24719243
OWN - NLM
STAT- MEDLINE
DCOM- 20150803
LR  - 20191210
IS  - 2048-8734 (Electronic)
IS  - 2048-8726 (Linking)
VI  - 3
IP  - 4
DP  - 2014 Dec
TI  - Direct stenting is an independent predictor of improved survival in patients 
      undergoing primary percutaneous coronary intervention for ST elevation myocardial 
      infarction.
PG  - 340-6
LID - 10.1177/2048872614530864 [doi]
AB  - AIMS: Randomised trials have shown that direct stenting (DS) is associated with 
      improved markers of reperfusion during primary percutaneous coronary intervention 
      (PPCI) for ST elevation myocardial infarction (STEMI). However, data evaluating 
      its impact on long-term clinical outcomes are lacking. We set out to evaluate the 
      effect of DS on mortality in a contemporary population of patients undergoing 
      PPCI for STEMI. METHODS: Consecutive patients undergoing PPCI for STEMI at two 
      high-volume UK heart attack centres between September 2008- December 2010 
      (n=1562) were included in the analysis. Local databases were analysed for patient 
      demographics, as well as details on PPCI strategy, including use of DS versus 
      predilatation (PD) followed by stenting, manual thrombus aspiration (MT) and 
      glycoprotein IIb/IIIa inhibitors (GPIs). National databases were interrogated for 
      in-hospital, 30-day and one-year mortality. To determine the impact of PPCI 
      strategy on one-year survival, multivariate logistic analysis was performed. 
      RESULTS: Altogether 489 patients underwent DS (31.3%) and 1073 (68.7%) received 
      PD prior to stenting. Patients receiving DS had reduced mortality at 30 days 
      (2.04 versus 4.66%, p=0.01) and one year (3.27 versus 8.48%, p=0.0001). After 
      multivariate adjustment, PD remained an independent predictor of one-year 
      mortality (odds ratio 2.42, 95% confidence interval 1.08-5.45, p=0.032) along 
      with age, cardiogenic shock, number of diseased vessels, and left main or 
      proximal left anterior descending artery intervention. However, neither GPI use 
      nor MT improved survival in either univariate or multivariate analyses. 
      CONCLUSIONS: In a contemporary, unselected population of patients undergoing PPCI 
      for STEMI, DS - when compared with stenting after PD - is independently 
      predictive of improved 30-day and one-year survival.
CI  - (c) The European Society of Cardiology 2014.
FAU - McCormick, Liam M
AU  - McCormick LM
AD  - Department of Cardiology, Papworth Hospital, UK.
FAU - Brown, Adam J
AU  - Brown AJ
AD  - Department of Cardiology, Papworth Hospital, UK.
FAU - Ring, Liam S
AU  - Ring LS
AD  - Department of Cardiology, Papworth Hospital, UK.
FAU - Gajendragadkar, Parag R
AU  - Gajendragadkar PR
AD  - Department of Cardiology, Papworth Hospital, UK.
FAU - Dockrill, Seth J
AU  - Dockrill SJ
AD  - Department of Cardiology, Norfolk and Norwich University Hospital, UK.
FAU - Hansom, Simon P
AU  - Hansom SP
AD  - Department of Cardiology, Norfolk and Norwich University Hospital, UK.
FAU - Giblett, Joel P
AU  - Giblett JP
AD  - Department of Cardiology, Papworth Hospital, UK.
FAU - Gilbert, Timothy J
AU  - Gilbert TJ
AD  - Department of Cardiology, Norfolk and Norwich University Hospital, UK.
FAU - Hoole, Stephen P
AU  - Hoole SP
AD  - Department of Cardiology, Papworth Hospital, UK.
FAU - West, Nick E J
AU  - West NE
AD  - Department of Cardiology, Papworth Hospital, UK nick.west@papworth.nhs.uk.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Multicenter Study
DEP - 20140409
PL  - England
TA  - Eur Heart J Acute Cardiovasc Care
JT  - European heart journal. Acute cardiovascular care
JID - 101591369
SB  - IM
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/mortality/*therapy
MH  - Percutaneous Coronary Intervention/*methods/mortality
MH  - Prospective Studies
MH  - *Stents
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Primary percutaneous coronary intervention
OT  - ST elevation myocardial infarction
OT  - direct stenting
OT  - mortality
OT  - predilatation
EDAT- 2014/04/11 06:00
MHDA- 2015/08/04 06:00
CRDT- 2014/04/11 06:00
PHST- 2014/04/11 06:00 [entrez]
PHST- 2014/04/11 06:00 [pubmed]
PHST- 2015/08/04 06:00 [medline]
AID - 2048872614530864 [pii]
AID - 10.1177/2048872614530864 [doi]
PST - ppublish
SO  - Eur Heart J Acute Cardiovasc Care. 2014 Dec;3(4):340-6. doi: 
      10.1177/2048872614530864. Epub 2014 Apr 9.