Comparison between Deflated Balloon-Facilitated Direct Stenting and Balloon Pre-Dilatation in ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention
Ahmed Abdelfattah Sayed Ali, Mahmoud Mohamed Ali Baraka, Ahmed Ibrahim Elbarbary, Ahmed Fathy Tamara- General Medicine
Abstract
Background
PPCI is considered to be the preferred reperfusion strategy for acute coronary syndrome (ACS). The goal of reperfusion is to resume normal blood flow to the cardiac tissues, and not just to achieve an open epicardial artery. Although no-reflow may occur regardless of the method of revascularization, it is easily diagnosed with certainty during acute percutaneous coronary intervention (PCI) in STEMI.
Objective
To evaluate the efficacy of Deflated Balloon-Facilitated Direct Stenting in comparison with routine Balloon Pre-dilatation in STEMI Patients undergoing PPCI.
Patients and Methods
It included 160 patients who were presented with ST segment elevation myocardial infarction (STEMI) and underwent primary PCI at Ain Shams University Hospitals and Misr University for Science and Technology (MUST) university hospital in the period of March 2021 to december 2021.
Results
In our study group 2 showed the best results as regards No-reflow (23.33% vs 6.67% vs 27.5% in group 1, 2 and 3 respectively) with p-value (0.011), final MBG (II-III) (76.67% vs 93.33% vs 72.5% in group 1, 2 and 3 respectively) with p-value (0.011) and final TIMI III (91.67% vs 95% vs 90% in group 1, 2 and 3 respectively) with p-value (0.838). It was found that group 1 showed the shortest procedure time (measured in minutes) (46.83±15.43 vs 52±13.54 vs 59.75±14.59, in group 1, 2 and 3 respectively) with p-value (0.054) and smallest contrast volume (measured in milliliters) (101±19.09 vs 120.67±28.99 vs 136.25±24.67, in group 1, 2 and 3 respectively) with p-value (<0.001). While group 3 had the worst outcomes among all groups.
Conclusion
Routine predilatation technique is associated with better results when compared with deflated balloon-facilitated direct stenting technique. One of the major disadvantages of deflated balloon-facilitated direct stenting is not being able to restore the flow distal to the lesion, which necessitate using balloon dilatation, leading to more incidence of no-reflow (we aquire the disadvantages of both techniques combined)
Abbreviations
ACS: Acute coronary syndrome; CAD: Coronary artery disease; CBC: Complete blood picture; CKD: Chronic kidney disease; CVS: cerebrovascular disease; DBDS: Deflated balloon facilitated direct stenting; DM: Diabetes Mellitus; DS: Direct stenting; ECG: Electrocardiogram; EF: Ejection fraction; FH: Family history; GP: Glycoprotein; HTN: Hypertension; IRA: Infarct related artery; LAD: Left anterior descending artery; LCX: Left circumflex artery; MACE: Major adverse cardiac events; MBG: Myocardial blush grade; MI: Myocardial infarction; NR: No reflow phenomenon; PAD: Peripheral arterial disease; PCI: Percutaneous coronary intervention; PD: Predilatation; PPCI: Primary percutaneous coronary intervention; RCA: Right coronary artery; STEMI: ST-segment elevation myocardial; SWMA: Segmental wall motion abnormalities; TIMI: Thrombolysis in myocardial infarction risk score