Editorial Comment Infarct Artery Stents: The First Year Joel K. Kahn, MD William Beaumont Hospital Royal Oak, Michigan The only thing constant in interventional cardiology is change. A short time ago the idea of implanting coronary stents in infarct- related arteries was viewed as radical, but a growing experience suggests otherwise. Berland et al. [1] now provide us the first analysis of the 1-yr outcome of patients treated with stents during an evolving myocardial infarction. Patients treated with balloon angioplasty during acute myocardial infarction run the risk of restenosis and repeat intervention. O’Keefe et al. [2] reported that 24% of patients required repeat angioplasty over a mean follow-up of 33 mo. Brodie et al. [3] reported a need for repeat angioplasty in 16% of patients within 6 mo of primary infarct angioplasty. The experience of Berland et al. [1] may compare favorably with these numbers, as only 11% of stented patients required repeat balloon angioplasty during 1 yr of follow-up. A full 72% of patients were completely event-free following infarct artery stenting [1]. Randomized studies are underway to provide additional informa- tion on the routine use of contemporary stent implantation during acute myocardial infarction. The results will be interesting, as the study patients reported by Berland et al. [1] were potentially biased toward adverse outcomes. Stents were not implanted electively and were placed for arterial dissection, abrupt closure, and suboptimal flow. Warfarin was used routinely, which is no longer a common practice pattern [4]. It was not discussed whether high-pressure dilatations were routinely applied to the stents upon implantation, as is now common practice. I am optimistic that stents, particularly heparin-coated devices, will play a larger role in our interventional therapy of acute myocardial infarction, but we must await the results of randomized trials underway for confirmation. REFERENCES 1. Berland G, Block P, DeLoughery T, Grunkemeier G: Clinical one-year outcomes after stenting in acute myocardial infarction. Cathet Cardiovasc Diagn 337–341, 1997. 2. O’Keefe JH, Rutherford BD, McConahay DR, et al.: Early and late results of coronary angioplasty without antecedent thrombolytic therapy for acute myocardial infarction. Am J Cardiol 64:1221– 1230, 1989. 3. Brodie BR, Grines CL, Ivanhoe R, Knopf W, Taylor G, O’Keefe J, Weintraub RA, Berdan LG, Tcheng TE, Woodlief LH, Califf RM, O’Neill WW: Six-month clinical and angiographic follow-up after direct angioplasty for acute myocardial infarction. Circulation 25:156–162, 1994. 4. Saito S, Hosokawa G, Kim K, Tanaka S, Miyake S: Primary stent implantation without coumadin in acute myocardial infarction. J Am Coll Cardiol 28:74–81, 1996. Catheterization and Cardiovascular Diagnosis 40:342 (1997) r 1997 Wiley-Liss, Inc.

Editorial comment: Infarct artery stents: The first year

Download PDF Report

Upload
joel-k-kahn
View
213
Download
0

Embed Size (px)

Citation preview

Editorial Comment

Infarct Artery Stents:The First Year

Joel K. Kahn, MD

William Beaumont HospitalRoyal Oak, Michigan

The only thing constant in interventional cardiology is change. Ashort time ago the idea of implanting coronary stents in infarct-related arteries was viewed as radical, but a growing experiencesuggests otherwise. Berland et al. [1] now provide us the firstanalysis of the 1-yr outcome of patients treated with stents duringan evolving myocardial infarction.Patients treated with balloon angioplasty during acute myocar-

dial infarction run the risk of restenosis and repeat intervention.O’Keefe et al. [2] reported that 24% of patients required repeatangioplasty over a mean follow-up of 33 mo. Brodie et al. [3]reported a need for repeat angioplasty in 16% of patients within 6mo of primary infarct angioplasty. The experience of Berland et al.[1] may compare favorably with these numbers, as only 11% ofstented patients required repeat balloon angioplasty during 1 yr offollow-up. A full 72% of patients were completely event-freefollowing infarct artery stenting [1].Randomized studies are underway to provide additional informa-

tion on the routine use of contemporary stent implantation duringacute myocardial infarction. The results will be interesting, as thestudy patients reported by Berland et al. [1] were potentially biased

toward adverse outcomes. Stents were not implanted electively andwere placed for arterial dissection, abrupt closure, and suboptimalflow. Warfarin was used routinely, which is no longer a commonpractice pattern [4]. It was not discussed whether high-pressuredilatations were routinely applied to the stents upon implantation,as is now common practice.I am optimistic that stents, particularly heparin-coated devices,

will play a larger role in our interventional therapy of acutemyocardial infarction, but we must await the results of randomizedtrials underway for confirmation.

REFERENCES

1. Berland G, Block P, DeLoughery T, Grunkemeier G: Clinicalone-year outcomes after stenting in acute myocardial infarction.Cathet Cardiovasc Diagn 337–341, 1997.

2. O’Keefe JH, Rutherford BD, McConahay DR, et al.: Early and lateresults of coronary angioplasty without antecedent thrombolytictherapy for acute myocardial infarction. Am J Cardiol 64:1221–1230, 1989.

3. Brodie BR, Grines CL, Ivanhoe R, Knopf W, Taylor G, O’Keefe J,Weintraub RA, Berdan LG, Tcheng TE, Woodlief LH, Califf RM,O’Neill WW: Six-month clinical and angiographic follow-up afterdirect angioplasty for acute myocardial infarction. Circulation25:156–162, 1994.

4. Saito S, Hosokawa G, Kim K, Tanaka S, Miyake S: Primary stentimplantation without coumadin in acute myocardial infarction. JAm Coll Cardiol 28:74–81, 1996.

Catheterization and Cardiovascular Diagnosis 40:342 (1997)

r 1997 Wiley-Liss, Inc.