| Differential effects of post-dilation after stent deployment in patients presenting with and without acute myocardial infarction. | |
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MedLine Citation:
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PMID: 21095289 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: In the practice of percutaneous coronary intervention, post-dilation often is performed after stent deployment to improve stent expansion. However, aggressive mechanical expansion is a risk factor of distal embolization and microvascular injury, especially for patients with acute myocardial infarction (AMI). Few studies have investigated the effects of post-dilation on medium-term clinical outcomes. METHODS AND RESULTS: Patients enrolled in the multicenter NHLBI Dynamic Registry between 2001 and 2006 were evaluated. Patients who were treated with ≥ 1 stent were studied. Patients with cardiogenic shock or history of coronary artery bypass graft surgery were excluded. Patients were followed up to 1 year. Because of the significant statistical interaction (P = .02) between post-dilation and AMI status on the hazard of death/myocardial infarction (MI), post-dilation effects were estimated separately for patients who did and did not present with an AMI. Among the 1,358 patients who presented with an AMI, post-dilation was associated with a significantly higher risk of death/MI (hazard ratio [HR] = 1.78, 95% CI 1.12-2.83, P = .01), not associated with the risk of repeat revascularization (HR = 1.15, 95% CI 0.81-1.62, P = .43). Among the 3,001 patients who did not present with AMI, post-dilation was not associated with risks of death/MI (HR = 1.08, 95% CI 0.77-1.50, P = .67) or repeat revascularization (HR = 1.17, 95% CI 0.93-1.47, P = .19). Similar effects were observed for the restricted analysis with additional adjustment for lesion characteristics among the 1,039 AMI patients and 2,179 non-AMI patients with a single lesion treated. CONCLUSIONS: Stent post-dilation is associated with an increased risk of death/MI in AMI patients but not in non-AMI patients. Further investigation is warranted. |
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Authors:
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Zhi-Jiang Zhang; Oscar C Marroquin; Roslyn A Stone; Joel L Weissfeld; Suresh R Mulukutla; Faith Selzer; Kevin E Kip |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: American heart journal Volume: 160 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-24 Completed Date: 2011-01-18 Revised Date: 2011-11-01 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 979-986.e1 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Epidemiology, School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, China. zhang.zj@msn.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cause of Death
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trends Coronary Circulation / physiology* Coronary Vessels / pathology* Dilatation, Pathologic Female Follow-Up Studies Humans Male Middle Aged Myocardial Infarction / mortality, physiopathology, therapy* Prospective Studies Risk Factors Stents / adverse effects* Survival Rate / trends United States / epidemiology |
| Grant Support | |
ID/Acronym/Agency:
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HL-33292/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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