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Clinical and angiographic outcomes after bare metal stents implantation for the patients with acute ST-elevation myocardial infarction: insights from multicenter trials

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Abstract

The general restenosis rate after emergent coronary stent implantation for ST-elevation myocardial infarction (STEMI) patients in Japan has yet to be fully established. Totally 696 STEMI patients without left main disease were enrolled for either ASPARAGUS (22 centers) or VAMPIRE (23 centers) trial. Out of these, 202 lesions in 202 patients with baseline and 6-month follow-up quantitative coronary angiography (QCA) data after emergent bare metal stent (BMS) implantation without either aspiration or distal protection devices were enrolled for this study. QCA was performed at an independent core laboratory. Minimal lumen diameter (MLD), reference diameter (RD) and diameter stenosis (DS) were estimated at pre, post and follow-up phase. Left ventricular ejection fraction was evaluated by quantitative left ventriculography. Six-month binary restenosis (DS >50%) rate and target lesion revascularization (TLR) were investigated. Six-month binary restenosis and TLR was found in 39 (19.3%) and 32 (18.6%), respectively. In the patients with binary restenosis, smaller pre-RD (2.46 ± 0.54 vs. 2.68 ± 0.73 mm, p = 0.03), post-MLD (2.08 ± 0.54 vs. 2.34 ± 0.52 mm, p = 0.009), acute gain (1.90 ± 0.49 vs. 2.13 ± 0.61 mm, p = 0.001) and follow-up RD (2.44 ± 0.67 vs. 2.71 ± 0.63 mm, p = 0.03) were observed. When the lesions are divided into quartiles of pre-RD (≤2.16, 2.18–2.61, 2.62–3.11, ≥3.12 mm), the binary restenosis rates were 26, 25.5, 16 and 10%, and TLR rate were 19.5, 29.6, 13.6 and 12%, respectively. RD was smaller at pre and follow-up than post phase (pre: 2.64 ± 0.71 mm; post: 2.89 ± 0.57 mm; follow-up: 2.66 ± 0.64 mm; pre vs. post: p < 0.001; post vs. follow-up: p = 0.001; pre vs. follow-up: p = 1.00). In this study cohort, the binary restenosis and TLR rate were considerable in patients with BMS for STEMI. The decrement of RD at follow-up period was common and it indicates that vessel shrinkage post PCI for acute myocardial infarction may be a myth. TLR rate was more than the binary restenosis rate in two quartiles of pre-RD. Robust guideline regarding stent type and revascularization for STEMI patients should be established.

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References

  1. Jeger RV, Radovanovic D, Hunziker PR, Pfisterer ME, Stauffer JC, Erne P, Urban P. Ten-year trends in the incidence and treatment of cardiogenic shock. Ann Intern Med. 2008;149:618–26.

    PubMed  Google Scholar 

  2. Saito S, Hosokawa G, Tanaka S, Nakamura S. Primary stent implantation is superior to balloon angioplasty in acute myocardial infarction: final results of the primary angioplasty versus stent implantation in acute myocardial infarction (PASTA) trial. PASTA Trial Investigators. Catheter Cardiovasc Interv. 1999;48:262–8.

    Article  CAS  PubMed  Google Scholar 

  3. Ikari Y, Sakurada M, Kozuma K, Kawano S, Kimura K, Suzuki T, Yamashita T, Takizawa A, Misumi K, Hashimoto H, Isshiki T, VAMPIRE_Investigators. Upfront thrombus aspiration in primary coronary intervention for patients with ST-segment elevation acute myocardial infarction: report of the VAMPIRE (VAcuuM asPIration thrombus REmoval) trial. J Am Coll Cardiol Interv. 2008;1:424–31.

    Google Scholar 

  4. Muramatsu T, Kozuma K, Tsukahara R, Ito Y, Fujita N, Suwa S, Koyama S, Saitoh M, Kamiya H, Nakamura M. Comparison of myocardial perfusion by distal protection before and after primary stenting for acute myocardial infarction: angiographic and clinical results of a randomized controlled trial. Catheter Cardiovasc Interv. 2007;70:677–82.

    Article  PubMed  Google Scholar 

  5. Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, Giambartolomei A, Brodie BR, Madonna O, Eijgelshoven M, Lansky AJ, O’Neill WW, Morice MC. Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med. 1999;341:1949–56.

    Article  CAS  PubMed  Google Scholar 

  6. Suzuki N, Kozuma K, Ishikawa S, Kyono H, Endo G, Terakura M, Suzuki M, Yokoyama N, Yamamoto Y, Isshiki T. The impact of persistent restenosis on Bx Velocity Stenting. Jpn J Interv Cardiol. 2005;20:131–6.

    Google Scholar 

  7. Farb A, Burke AP, Kolodgie FD, Virmani R. Pathological mechanisms of fatal late coronary stent thrombosis in humans. Circulation. 2003;108:1701–6.

    Article  PubMed  Google Scholar 

  8. Laarman GJ, Suttorp MJ, Dirksen MT, van Heerebeek L, Kiemeneij F, Slagboom T, van der Wieken LR, Tijssen JG, Rensing BJ, Patterson M. Paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention. N Engl J Med. 2006;355:1105–13.

    Article  CAS  PubMed  Google Scholar 

  9. Spaulding C, Henry P, Teiger E, Beatt K, Bramucci E, Carrie D, Slama MS, Merkely B, Erglis A, Margheri M, Varenne O, Cebrian A, Stoll HP, Snead DB, Bode C. Sirolimus-eluting versus uncoated stents in acute myocardial infarction. N Engl J Med. 2006;355:1093–104.

    Article  CAS  PubMed  Google Scholar 

  10. Stadius ML, Alderman EL. Coronary artery revascularization. Critical need for, and consequences of, objective angiographic assessment of lesion severity. Circulation. 1990;82:2231–4.

    CAS  PubMed  Google Scholar 

  11. Watada H, Ito H, Oh H, Masuyama T, Aburaya M, Hori M, Iwakura M, Higashino Y, Fujii K, Minamino T. Dobutamine stress echocardiography predicts reversible dysfunction and quantitates the extent of irreversibly damaged myocardium after reperfusion of anterior myocardial infarction. J Am Coll Cardiol. 1994;24:624–30.

    Article  CAS  PubMed  Google Scholar 

  12. Chen C, Ma L, Dyckman W, Santos F, Lai T, Gillam LD, Waters DD. Left ventricular remodeling in myocardial hibernation. Circulation. 1997;96:II-46–50.

    Google Scholar 

  13. Lilli A, Vecchio S, Vittori G, Consoli L, Chechi T, Margheri M. Severe diffuse coronary artery spasm in the early phase of cardiogenic shock. Int J Cardiol. 2009;134:e103–4.

    Article  PubMed  Google Scholar 

  14. Costa MA, Sabate M, Angiolillo DJ, Hu P, Jimenez-Quevedo P, Corros C, Alfonso F, Hernandez-Antolin R, Macaya C, Bass TA. Relocation of minimal luminal diameter after bare metal and drug-eluting stent implantation: incidence and impact on angiographic late loss. Catheter Cardiovasc Interv. 2007;69:181–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan

    Nobuaki Suzuki, Ken Kozuma & Takaaki Isshiki

  2. Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan

    Kengo Tanabe

  3. Division of Cardiology, Tokai University School of Medicine, Isehara, Japan

    Yuji Ikari

  4. Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan

    Toshiya Muramatsu

Authors
  1. Nobuaki Suzuki
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  2. Ken Kozuma
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  3. Kengo Tanabe
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  4. Yuji Ikari
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  5. Toshiya Muramatsu
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  6. Takaaki Isshiki
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Corresponding author

Correspondence to Nobuaki Suzuki.

Additional information

Investigators of VAMPIRE and ASPARAGUS are given in the Appendix.

Appendix

Appendix

The VAMPIRE trial investigators (clinical sites)

Shigeo Kawano, Hiroshi Ito, Kenshi Fujii (Sakurabashi Watanabe Hospital), Takaaki Isshiki, Ken Kozuma (Teikyo University School of Medicine), Yuji Ikari, Kengo Tanabe, Kazuhiro Hara (Mitsui Memorial Hospital), Masami Sakurada, Kikuchi Masao (Sekishinkai Sayama Hospital), Takaaki Katsuki (Jichi Medical University), Kazuo Kimura (Yokohama City University Medical Center), Takahiko Suzuki, Shigenori Ito, Tetsuo Matsubara, Tatsuo Ito (Toyohashi Heart Center, Toyohashi), Takehiro Yamashita, Kazue Oshiro, Toru Morita (Cardiovascular Center Hokkaido Ohno Hospital), Akinori Takizawa, Kouichiro Murata (Shizuoka City Hospital), Kazuo Misumi (Chiba Nishi General Hospital), Kazuhisa Yamane (Ashikaga Red Cross Hospital, Ashikaga), Takeshi Kimura, Masanao Toma (Kyoto University School of Medicine), Ichiro Michishita (Yokohama Sakae Kyosai Hospital), Hideo Tamai, Masaharu Okada (Shiga Medical Center for Adults), Shigeru Nakamura, Osamu Kato (Kyoto Katsura Hospital), Shingo Yamamoto (Tsuruoka Kyoritsu Hospital), Masao Yamasaki, Toshihiro Morita (University of Tokyo), Kenji Horiuchi (Saiseikai Kumamoto Hospital, Kumamoto), Yoshihisa Nakagawa, Toshihiko Yoshida (Matsudo City Hospital), Yutaka Koyama, Masayoshi Sakakibara (Shin Katsushika Hospital), Kenji Ando, Hiroyoshi Yokoi, Masakiyo Nobuyoshi (Kokura Memorial Hospital), Masaharu Ishihara (Hiroshima City Hospital), Hitoshi Yokoyama (Hirosaki University Hospital).

The ASPARAGUS trial investigators (clinical sites)

Toshiya Muramatsu, Reiko Tsukahara, Yoshiaki Ito (Saiseikai Yokohama-City Eastern Hospital), Nakamura, Masato (Toho University Ohashi Medical Center), Naoya Fujita (Eastern Japan Medical Center), Satoru Suwa (Juntendo University Shizuoka Hospital), Shiho Koyama (Saiseikai Noe Hospital), Masahiko Saitoh (Ageo Central General Hospital), Haruo Kamiya (Japanese Red Cross Nagoya First Hospital), Kojiro Awano (Miki City Hospital), Yuji Hamazaki (School of Medicine, Showa University), Yuhki Horita (Ishikawa Prefectural Central Hospital), Shigeki Ito (Nishitokyo Central General Hospital), Koichiro Iwasaki (Cardiovascular Center Sakakibara Hospital), Shigeo Kawano (Sakurabashi Watanabe Hospital), Masunori Mori (Kasai City Hospital), Junro Namiki (Kanto Rosai Hospital), Akitsugu Oida (Dokkyo University School of Medicine), Yukio Ozaki (School of Medicine Fujita Health University), Akihiro Shirasaka (Iseikai Hospital), Takeshi Tsuchiya (Kanazawa Cardiovascular Hospital), Kinzo Ueda (Rakuwakai Otowa Hospital), and Yoshinori Yasaka (Toyooka Hospital).

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Suzuki, N., Kozuma, K., Tanabe, K. et al. Clinical and angiographic outcomes after bare metal stents implantation for the patients with acute ST-elevation myocardial infarction: insights from multicenter trials. Cardiovasc Interv and Ther 25, 98–104 (2010). https://doi.org/10.1007/s12928-010-0020-5

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  • DOI: https://doi.org/10.1007/s12928-010-0020-5

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