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Previous studies have shown that direct stenting may improve clinical outcomes and reduce the incidences of slow and no-reflow during primary percutaneous coronary interventions (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Regardless of diabetes status, hyperglycemia at admission in STEMI patients is associated with worse outcomes and microvascular obstruction. The aim of this study is to evaluate in-hospital outcomes of direct stenting compared with stenting after predilation in patients with STEMI and hyperglycemia at admission.
Data were collected from all patients (n = 1103) with STEMI admitted to the coronary care unit and submitted to PCI from 2006 to 2014. Plasma glucose was measured at hospital admission. Hyperglycemia was defined as plasma glucose of 7.77 mmol/L (140 mg/dL), regardless of the diabetic status. A total of 511 (46.3%) patients with hyperglycemia at admission were included in the analysis. The clinical and angiographic characteristics, in-hospital outcomes, as well as predictors of angiographic no-reflow were analyzed. The composite of in-hospital death, myocardial infarction and stent thrombosis were defined as major adverse cardiac events (MACE).
Direct stenting was performed in 252 (49.3%) patients, and 259 (50.7%) patients received stenting after predilation. The groups were comparable by age and sex. The rates of diabetes mellitus, hypertension, and previous myocardial infarction were comparable between groups. Totally occluded culprit arteries (48.8% vs 83%; p<0.001) and multivessel disease (23.8% vs 39.4%; p<0.001) were more rarely identified during PPCI in direct stenting group. There were no difference in rates of stent thrombosis (1.2% vs 0.8%; p=0. 631) and repeat myocardial infarction (1.2% vs 1.2%; p=0.973). The rates of failed PCI (4.4% vs 12,4%; p=0.001), death (4% vs 8.9%; p=0.024), MACE (4.8% vs 10.4%; p=0.016), and angiographic no-reflow (2% vs 11.6%; p<0.001) were significantly lower in the direct stenting group. After multivariate adjustment, predilation remained an independent predictor of no-reflow [odds ratio (OR) 3.9; 95% confidence interval (CI) 1.4-10.4; p=0.007] along with totally occluded culprit arteries (OR 13; 95% CI 1.7-98.5; p=0.013) and blood glucose level (OR 1.13; 95% CI 1.05-1,21; p=0.002).
Direct stenting in patients with STEMI and hyperglycemia was associated with better clinical and procedural outcomes compared with stenting after predilation. Predilation was an independent predictor of no-reflow during PCI.
CORONARY: Acute Myocardial Infarction