One-week and six-month angiographic controls of stent implantation after occlusive and nonocclusive dissection during primary balloon angioplasty for acute myocardial infarction

We prospectively assessed in 124 consecutive patients by means of I-week and 6-month follow-up angiograms the rate of reocclusion and restenosis of coronary stenting with Palmaz-Schatz stents after occlusive and nonocclusive dissection during primary balloon angioplasty for acute myocardial infarction (AMI), Patients were further evaluated clinically at 1 year, Stenting was performed on large (>3,2 mm) coronary arteries for suboptimal results (47%), occlusive (8%), or nonocclusive dissections (45%) after balloon angioplasty. Stents were delivered using the bare stent technique and high pressure inflations (>12 atm), All patients received ticlopidine 250 mg (500 mg if weight was >80 kg) and aspirin 100 mg for 1 month, No patient received warfarin, At 1 week, 6 patients died of cardiogenic shock and 2 of right ventricular infarction, One subacute occlusion occurred at day 14, At 6 months, in 95 patients, the angiographic restenosis rate (>50% diameter stenosis) was 19%. One-year clinical follow-up, available in 55 patients, indicated cardiac death in 5, and repeat revascularization in 3, Thus, coronary stenting on large (>3,2 mm) coronary arteries after occlusive and nonocclusive dissection during primary balloon angioplasty for AMI using bare Palmaz-Schatz stents, high pressures, ticlopidine, and aspirin is safe, Our reocclusion and restenosis rates are similar to those of trials on elective stenting in stable patients. (C) 1997 by Excerpta Medica, Inc.