A comparison of success rates of stenting compared to balloon angioplasty demonstrates that stenting improves patient outcomes over angioplasty alone. Success rates of stenting and balloon angioplasty in patients with acute myocardial infarction (AMI) after failed thrombolysis resulted in a myocardial salvage index significantly greater in those receiving stents group than in those receiving angioplasties (Schömig 2004). In particular, major bleeding occurred equally as often in both groups, while one-year mortality was 8% in the stent group versus 12% in the angioplasty group (Schömig 2004). Patients who received either a percutaneous transluminal angioplasty for ostial atherosclerotic renal artery stenosis with a similar procedure with stent placement resulted in 57% primary success rate for angioplasty-only group but an 88% rate for those receiving stent placement with the angioplasty (van de Ven et al. 1999). After six months patients receiving stents demonstrate improved risks for restenosis and better patency rates (van de Ven et al. 1999). Despite these differences in outcome, six months after treatment, no clinical differences were found in intention to treat measures (van de Ven et al. 1999).
Although balloon angioplasty demonstrates no superiority over thrombolysis in treating AMI, the addition of stenting to the angioplasty in immediate treatment after thrombolysis demonstrates a superior patient outcome in terms of a significant reduction in cardiac events (Scheller et al. 2003). These results hold even in comparison to delayed stenting in those patients experiencing AMI after thrombolysis (Scheller et al. 2003).
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Earlier studies have shown poorer results for patients receiving angioplasties instead of immediate thrombolysis due to higher rates of bleeding, transfusions, and emergency coronary artery bypass grafting (Scheller et al. 2003). However, patients undergoing angioplasty with stenting within six hours after thrombolysis, experienced superior patient outcomes even compared to those receiving stents two weeks after thrombolysis (Scheller et al. 2003). Immediate stenting is superior at improving adverse event-free survival including preventing recurrent ischemia and improved LV function as (Scheller et al. 2003). Stenting also has been shown to improve outcomes for patients with ST-segment elevation myocardial infarction, with similar improvements whether for direct stenting or stenting as part of balloon angioplasty (Tacoy et al. 2009). Clinical outcomes do not appear to be significantly altered in either case, although thrombolysis frame count is improved in direct stenting (Tacoy et al. 2009).
When long-term benefits are considered, 24-month patient assessments also are indicative of stenting as being the superior treatment (Suryapranata et al. 2001). Death or reinfarction rates were 4% after stenting but 11% after balloon angioplasty alone (Suryapranata et al. 2001). Target vessel revascularization was also more than twice as likely after angioplasty compared to stenting (34% compared to 13%) (Suryapranata et al. 2001). By all measures primary stenting for AMI produced significantly improved long-term clinical outcomes for patients and did not increase overall medical costs (Suryapranata et al. 2001).
Cardiogenic shock (CS) is a major cause of mortality in myocardial infarction patients with most deaths taking place within 30 days (half occurring within 48 hours) (Marcolino et al 2012). Following the course of patients receiving stenting over a period of years revealed that CS significantly increases the risk of mortality and also generates poorer long-term prognoses for up to 48 months after onset (Marcolino et al 2012). Adding CS increases the number of complications and worsens the clinical outlook for these patients including increasing the likelihood of renal impairment, multivessel disease and left main coronary disease (Marcolino et al 2012). Thus, although stent implantation has significant benefits in reducing mortality from myocardial infarction, CS remains a significant and severe risk for these patients.
- Marcolino, M. S., Simsek, C., de Boer, S. P. M., van Domburg, R. T., van Geuns, R-J., de Jaegere, P., Akkerhuis, K. M. et al. (2012). Short- and long-term major adverse cardiac events in patients undergoing percutaneous coronary intervention with stenting for acute myocardial infarction complicated by cardiogenic shock. Cardiology, 121, 47-55. DOI: 10.1159/000336154.
- Scheller, B., Hennen, B., Hammer, B., Walle, J., Hofer, C., Hilpert, V., Winter, H. et al. (2003). Beneficial effects of immediate stenting after thrombolysis in acute mycardial infarction. Journal of the American College of Cardiology, 42(4), 634-641. DOI: 10.1016/S0735-1097(03)00763-0
- Schömig, A., Ndrepepa, G., Mehilli, J., Dirschinger, J., Nekolla, S. G., Schmitt, C., Martinoff, S. et al. (2004). A randomized trial of coronary stenting versus balloon angioplasty as a rescue intervention after failed thrombolysis in patients with acute myocardial infarction. Journal of the American College of Cardiology, 44(10), 2073-2079. DOI: 10.1016/j.jacc2004.09.043
- Suryapranata, H., Ottervanger, J. P., Nibbering, E., van’t Hof, A. W. J., Hoorntje, J. C. A., de Boer, M. J. Al & Zijlstra, F. (2001). Long term outcome and cost-effectiveness of stenting versus balloon angioplasty for acute myocardial infarction. Heart, 85(6), 667-671.
- Tacoy, G., Yazici, G. E., Erden, M. & Timurkaynak, T. (2009). The comparision of early and late outcome of direct and conventional stenting of patients with stelevation myocardial infarction. Therapeutic Advances in Cardiovascular Disease, 3(3), 181-186.
- Van de Ven, P. J. G., Kaatee, R., Beutler, J. J., Beek, F. J. A., Woittiez, A-J. J., Buskens, E., Koomans, H. A. & Mali, W. P. Th. (1999). Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: A randomised trial. The Lancet, 353(9149) 282-286. DOI: 10.1016/S0140-6736(98)04432-8
