山梨医科大学雑誌　第14巻2号　043-049(1999)

Adjunctive Coronary Stenting Improves the Six-Month
Rate of Stenosis in Patients with Acute Myocardial
Infarction vs. Direct Balloon Angioplasty Alone and
Adjunctive Directional Coronary Atherectomy

Hajime TAKANO, Naohiko TSUYUGUCHI, Yuzuru MATSUYAMA,
Katsuya ISHIHARA and Jun-ei OBATA

Abstract: Although direct angioplasty has proved useful in treating patients with acute myocardial infarction, restenosis continues to be a significant problem. Coronary stenting and directional atherectomy (DCA) have been sometimes successful in patients with acute coronary syndrome in whom direct angioplasty resulted in suboptimal results. We investigated whether coronary stenting could reduce the incidence of restenosis in 91 patients with acute myocardial infarction who underwent direct angioplasty alone, adjunctive coronary stenting or adjunctive DCA within 6 hours of the onset of AMI. Successful fine revascularization was defined as a residual stenosis＜25％ with a TIMI grade III flow. Direct angioplasty achieved fine revascularization in 46 patients (PTCA group). The remaining 45 patients underwent adjunctive coronary stenting (Stent group, n＝23) or adjunctive DCA (DCA group, n＝22) because of direct angioplasty failed to achieve fine revascularization due to coronary dissection or recoil in these patients. Successful revascularization was achieved in patients (96％) in the Stent group and patients (91％) in the DCA group. Revascularization of target lesions was required before discharge in 8 patients in the PTCA group, and within 6 months in 13 PTCA patients, 2 Stent patients and 7 DCA patients. The minimal luminal diameter at 6 months was significantly greater in the Stent group (2.79±.62 mm) than in the DCA group (1.88±.89 mm) and the PTCA group (1.70±.72 mm) (p＜0.01). The％diameter stenosis was significantly smaller in the Stent group (18.6±11.4％) compared with the DCA group (43.5±27.6％) and the PTCA group (45.2±24.1％) (p＜0.01). Thus, adjunctive coronary stenting and adjunctive DCA were useful bail-out strategies. Coronary stenting but not DCA, reduced the 6-month rate of restenosis,
achieving a large lumen.

Key words: Restenosis, Stenting, Acute myocardial infarction




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