Coronary Palmaz-Schatz stent implantation in acute myocardial infarction.

OBJECTIVE To investigate the feasibility of coronary stenting in acute myocardial infarction. DESIGN Prospective observational study. PATIENTS 80 patients undergoing direct balloon angioplasty for acute myocardial infarction who had coronary Palmaz-Schatz stents implanted during a 3 year study period. Indications for stenting were abrupt reocclusion, large dissection with threatened reocclusion, and failure to achieve brisk flow of contrast by angioplasty alone. INTERVENTIONS After stenting, 50 patients were treated by conventional anticoagulation and 30 patients received antiplatelet therapy with aspirin and ticlopidine. MAIN OUTCOME MEASURES Death and subacute reocclusion within two weeks. RESULTS Coronary stenting fully restored vessel patency in 79 patients (98.8%). 10 of 14 patients with symptoms of Killip class IV on admission were discharged from hospital alive. Three of the 66 patients with symptoms of Killip classes I-III died in hospital. Repeat angiography in 59 of these patients, showed 3 symptomatic and 2 silent reocclusions (reocclusion rate 8.5%). No stent thromboses were detected in patients treated with ticlopidine. CONCLUSIONS Coronary stenting is a safe and effective treatment for complicated direct balloon angioplasty in acute myocardial infarction. In patients with symptoms of Killip classes I to III the risk of subacute reocclusion is comparable to that of bail-out stenting after elective balloon angioplasty.