Primary stent implantation without coumadin in acute myocardial infarction

Cardiology Center, Shonan Kamakura General Hospital, Kamakura, Japan.

OBJECTIVES: We tested the feasibility and efficacy of primary stent implantation without Coumadin in 74 patients within 8 h of the onset of acute myocardial infarction. BACKGROUND: Although stent implantation in patients with effort angina provides better short- and long-term outcomes than balloon angioplasty, it is not clear whether primary stent implantation is applicable or effective in acute myocardial infarction. METHODS: Primary sent implantation was attempted when 1) the lesion was not located distally in the main coronary branches, 2) the coronary artery did not show any severe calcification or excessive bending proximal to the lesion on fluoroscopy, and 3) the arterial diameter was > or = 2.5 mm. The results (group S) were compared with those of primary balloon angioplasty (group P). Poststenting regimens contained ticlopidine and aspirin without Coumadin. Poststenting inflation was performed with > or = 12 atm. RESULTS: Stent implantation was successful in 72 patients. Stent thrombosis was noted in only one patient who was not given ticlopidine, aspirin or Coumadin. The rates of restenosis and frequency of major clinical events during the hospital period in groups S and P were 0% versus 13.2% (p = 0.007) and 2.8% versus 18.6% (p = 0.009), respectively. Kaplan-Meier analysis demonstrated that cumulative 90-day clinical event-free rates in groups P and S were 98.1 +/- 16.0% versus 79.4 +/- 43.7% (p = 0.0068), and that 180-day rates were 86.5 +/- 38.4% versus 64.2 +/- 49.7% (p = 0.014). CONCLUSIONS: Primary stent implantation can improve clinical outcomes of patients with acute myocardial infarction when the stent is dilated adequately and antiplatelet drugs are used.

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