Is postdilatation with a noncompliant balloon necessary after coronary stent deployment during primary angioplasty?

Abstract

Postdilatation (PD) with noncompliant balloon during elective percutaneous coronary intervention (PCI) is performed usually in clinical practice in order to optimize stent expansion. However, current knowledge about its use in patients undergoing primary PCI is controversial. This study aims to evaluate the angiographical and clinical results of PD in patients who underwent primary PCI with drug eluting stents (DESs).

A total of 405 consecutive patients (mean age 56.9 ± 12.3 years; 302 male) with ST elevation myocardial infarction were evaluated retrospectively. Patients received DES with or without predilatation according to physician's discretion. Eligible patients were divided into 2 groups based on PD procedure. The clinical end-points were death, target vessel revascularization (TVR) and stent thrombosis at 6 months after PCI. The angiographic end-points were postprocedural correct Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC), final TIMI flow, and myocardial blush grade (MBG).

PD was performed in 214 patients (52.8%). Angiographical parameters such as TIMI flow, cTFC, and MBG did not differ after PD (P>0.05). During 6-month follow-up, TVR and stent thrombosis rates were lower in the PD group (6 vs. 16, P=0.03; and 3 vs. 10, P=0.04, respectively). PD and diabetes were detected as independent predictors of MACE (β=0.52, P=0.01, and β=-0.47, P=0.02; respectively).

Our study revealed that PD does not yield adverse effects on final angiographic parameters when performed during primary PCI. Besides PD seems to decrease probability of stent thrombosis and TVR.