Abstract
BackgroundHigh-pressure inflation for coronary stent deployment is universally performed. However, the duration of inflation is variable and does not take into account differences in lesion compliance. We developed a standardized pressure optimization protocol (POP) using inflation pressure stability rather than an arbitrary inflation time or angiographic balloon appearance for stent deployment. Whether this approach improves long-term outcomes is unknown.
Methods and results792 patients who underwent PCI using either rapid inflation/deflation (n=376) or POP (n=416) between January 2009 and March 2014 were included. Exclusion criteria included PCI for acute myocardial infarction, in-stent restenosis, chronic total occlusion, left main, and saphenous vein graft lesions. Primary endpoint was target vessel failure [TVF=combined end point of target vessel revascularization (TVR), myocardial infarction, and cardiac death]. Outcomes were analyzed in the entire cohort and in a propensity analysis. Stent implantation using POP with a median follow-up of 1317days was associated with lower TVF compared with rapid inflation/deflation (10.1 vs. 17.8%, P<0.0001). This difference was driven by a decrease in TVR (7 vs. 10.6%, P=0.0016) and cardiac death (2.9 vs. 5.8%, P=0.017) while there was no difference in myocardial infarction (1 vs. 1.9%, P=0.19). In the Cox regression model, deployment using POP was the only independent predictor of reduced TVF (HR 0.43; 0.29-0.64; P<0.0001). In the propensity analysis (330 patients per group) TVF remained lower with POP vs. rapid inflation/deflation (10 vs. 18%, P<0.0001).
ConclusionsStent deployment using POP led to reduced TVF compared to rapid I/D. These results recommend this method to improve long-term outcomes. (c) 2017 Wiley Periodicals, Inc.