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Minerva Cardioangiologica 2020 Dec 01

DOI: 10.23736/S0026-4725.20.05396-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Role of stent oversizing in patients undergoing primary percutaneous coronary intervention. An open-labeled randomized controlled trial

Seyed A. BANIFATEMEH 1, 2, Parham SADEGHIPOUR 1, 3, Mohammad J. ALEMZADEH-ANSARI 1, Amir A. FAKHRABADI 1, Fereshte ZOLFAGHARI 1, Ali ZAHEDMEHR 1, Bahram MOHEBBI 1, Reza KIANI 1, Farshad SHAKERIAN 1, Ali RASHIDINEJAD 1, Zahra HOSSEINI 1, Ata FIROUZI 1

1 Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran; 2 Department of Cardiovascular Medicine, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran; 3 Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Iran


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BACKGROUND: In patients with ST-segment-elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PPCI) is the treatment of choice. Stent undersizing might occur due to catecholamine release and coronary spasm. Although routine oversizing has been promising in several investigations, it has never been tested in randomized clinical trials. In this single-center open-label randomized clinical trial, we evaluated the role of stent oversizing in PPCI.
METHODS: Candidates for PPCI were randomly divided into oversized and non-oversized groups. In the oversized group, the stent was oversized by 10% according to the mean lumen diameter, retrieved from the quantitative coronary analysis. Primary composite endpoints were defined as the occurrence of complete total ST-segment (STR)resolution and postprocedural thrombolysis in myocardial infarction (TIMI) flow grade III.
RESULTS: The study population was comprised of 122 patients, allocated to the oversized group (n = 61) and the non-oversized group (n = 61). There was no significant difference between the 2 groups regarding the final TIMI flow grade. Complete STR was marginally more favorable in the non-oversized group (56.05 ± 55.12 vs 64.64 ± 23.28; P = 0.056). The troponin ratio, CK-MB ratio, and 6-month follow up outcome-defined as target lesion revascularization, heart failure, and cardiovascular death-were comparable between the 2 groups.
CONCLUSIONS: Our study showed that routine oversizing in patients undergoing PPCI had no benefit regarding ST-segment resolution and the final TIMI flow, as well as hard cardiac events, during the follow-up.


KEY WORDS: Primary percutaneous coronary intervention; ST-segment elevation myocardial infarction; Stent underexpansion; Stent oversizing

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