A prospective evaluation of angiography-guided coronary stent implantation with high versus very high balloon inflation pressure

Barry F. Uretsky, Salvatore Rosanio, Stamatios Lerakis, Fen Wei Wang, Matt Smiley, George A. Stouffer, Monica Tocchi, Pedro Estella

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background: High inflation pressure (HP) after coronary stent deployment has become a standard approach because it has been associated with a decreased subacute stent thrombosis (SAT) rate. However, the impact of HP on long-term outcomes is still unclear. We compared the long-term results of a strategy of increasing HP (≥12 atm) until the achievement of angiographic success (<20% residual stenosis) with a prespecified very high inflation pressure (VHP) strategy of 20 atm without intermediate inflations. Methods and Results: We conducted a parallel-group, nonrandomized study to evaluate the short- and long-term results in 136 consecutive eligible patients who underwent successful single Palmaz-Schatz stent implantation in vessels ≥3 mm. Major adverse cardiac events (MACE), that is, death, myocardial infarction, and target lesion revascularization (TLR), were monitored for a minimum of 6 months. No significant differences were observed between the two strategies in terms of final minimal lumen diameter (HP, 3.0 ± 0.5 vs VHP, 3.1 ± 0.5 mm) and acute gain (HP, 2.1 ± 0.7 vs VHP, 2.2 ± 0.6). The overall rate of subacute stent thrombosis was 0.7%. During a 405 ± 148-day follow-up, 21 (28.8%) patients in the VHP group and 6 (9.5%) in the HP group (P = .005) had MACE, with a TLR rate of 27.4% versus 7.9% (P = .009), respectively. By multivariate analysis, the use of VHP increased the odds of long-term MACE by a factor of 3.48 (P = .009). Among patients undergoing TLR, those treated with VHP had a greater lumen loss (HP, 1.83 ± 0.57 vs VHP, 2.15 ± 0.36 mm, P = .02) and a more frequent pattern of diffuse restenosis (71% vs 16%, P = .06). Conclusions: In our study, the two strategies had similar acute and short-term results, but VHP was associated with a poorer long-term outcome. These data provide a rationale for a less aggressive strategy for stent deployment by optimizing rather than attempting to maximize inflation pressure and stent expansion.

Original languageEnglish
Pages (from-to)804-812
Number of pages9
JournalAmerican Heart Journal
Volume140
Issue number5
DOIs
StatePublished - 2000
Externally publishedYes

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