Effect of Stent Post Dilatation Versus No Post Dilatation in Patients with STEMI Treated by Primary PCI on No Reflow and in-hospital Outcome

• 出版年: International Journal of the Cardiovascular Academy
• 主要な著者: Sarah Gamal, Hussein Shaalan, Tamer M. Abu Arab, Mina M. Iskandar
• フォーマット: 論文
• 言語: 英語
• 出版事項: The Society of Cardiovascular Academy 2025-09-01
• 主題: stemi; percutaneous coronary intervention; no-reflow phenomenon; timi flow; myocardial blush grade; post-dilatation; in-hospital outcomes
• オンライン･アクセス: https://ijcva.org/articles/effect-of-stent-post-dilatation-versus-no-post-dilatation-in-patients-with-stemi-treated-by-primary-pci-on-no-reflow-and-in-hospital-outcome/doi/ijca.2025.20982
• ISSN: 2405-8181; 2405-819X

Background and Aim: Percutaneous coronary intervention (PCI) remains the primary modality of choice for achieving reperfusion in patients with acute coronary syndrome. However, complications such as no-reflow phenomenon can occur. Stent post-dilatation (SPD) is common in non-infarct settings, however its use during acute myocardial infarction is controversial. To investigate impact of SPD versus no SPD in ST elevation myocardial infarction (STEMI) cases undergoing primary PCI on incidence of no-reflow phenomenon and in-hospital outcomes. Materials and Methods: A prospective, single-center, randomized controlled trial was conducted on 300 STEMI cases who presented to Ain Shams University Hospitals between February 2024 and August 2024. Following successful stent implantation, confirmed thrombolysis in myocardial infarction (TIMI) III flow, and adequate stent expansion, cases were randomly stratified into two groups: group I (n=150), which underwent SPD, and group II (n=150), which did not receive SPD. Post-procedural TIMI flow and myocardial blush grade (MBG) were assessed and compared between the two groups. In-hospital clinical outcomes were likewise evaluated. Results: Cases who underwent SPD (group I) showed significantly lower TIMI flow and MBG than cases in group II; consequently, group I showed elevated prevalence of transient no-reflow (43.3% vs. 4% in group II). There is a relation between SPD and occurrence of no-reflow. In-hospital major adverse cardiac events rates were comparable between two groups, with no substantial variation detected. Longer chest pain duration, higher non-compliant (NC) balloon inflation pressure, higher NC balloon to stent size ratio, and longer stent length were strongly and negatively correlated with TIMI flow and MBG outcomes, leading to poorer post procedural results. Conclusion: Post-stent dilatation during primary PCI in STEMI patients was associated with a higher incidence of transient no-reflow immediately following the procedure. However, this did not translate into a significant difference in short-term-in-hospital clinical outcomes-likely due to prompt intra-procedural management of no-reflow.