Article

PDF
Access to the PDF text
Advertising


Free Article !

Archives of cardiovascular diseases
Volume 110, n° 4
pages 206-213 (avril 2017)
Doi : 10.1016/j.acvd.2016.09.005
Received : 17 Mars 2016 ;  accepted : 13 September 2016
Cliinical research

Primary angioplasty: Effect of deferred stenting on stent size
Angioplastie primaire : impact de la stratégie de stenting différé sur la taille du stent
 

Brahim Harbaoui a, b, Philippe Emsellem a, Emmanuel Cassar a, Cyril Besnard a, Raphael Dauphin a, Pascal Motreff c, d, Pierre-Yves Courand a, b, Pierre Lantelme a, b,
a Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France 
b Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude-Bernard Lyon 1, Hospices Civils de Lyon, 69100 Lyon, France 
c Université d’Auvergne, Cardio-Vascular Interventional Therapy and Imaging, Image Science for Interventional Techniques, UMR 6284, 63000 Clermont-Ferrand, France 
d University Hospital of Clermont-Ferrand, Cardiology Department, 63000 Clermont-Ferrand, France 

Corresponding author. Cardiology Department, Hôpital de la Croix-Rousse, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France.
Summary
Background

Primary angioplasty with immediate stenting (IS) is the gold standard for ST-segment elevation myocardial infarction (STEMI). Deferred stenting (DS) has been proposed to limit periprocedural complications, and may influence stent size because of thrombus and spasm alleviation.

Aim

We sought to study the effect of DS on stent size.

Methods

Over the study period, 258 patients underwent primary angioplasty for STEMI (DS, n =84; IS, n =174). An informative coronary angiogram run – i.e. allowing for proper lesion analysis – was selected and anonymized by an independent operator. Two experienced operators randomly analysed these runs, and proposed stent dimensions after having measured vessel diameter and lesion length by quantitative coronary analysis. The primary objective was the variation in stent size between the two coronary angiograms.

Results

The median delay between the two coronary angiograms was 2 days. Overall, the stent length was shorter (–1.64mm; P =0.030) and its diameter was larger (+0.13mm; P <0.001) during the second coronary angiogram, especially in the right coronary arteries.

Conclusions

DS led to the implantation of a larger and shorter stent; this is probably because DS allows for more accurate assessment of the residual lesion after relief of spasm and thrombus, and may have clinical consequences in terms of stent thrombosis and restenosis.

The full text of this article is available in PDF format.
Résumé
Contexte

L’angioplastie primaire avec stenting immédiat (SI) est le traitement de référence du syndrome coronarien aigu avec élévation du ST. La stratégie de « stenting différé » (SD) a été développée afin de limiter les complications péri-procédurales et pourrait influencer les dimensions du stent implanté du fait de la régression des phénomènes de spasme et de thrombose. La stratégie SD pourrait modifier la taille du stent implanté.

Objectif

Nous avons cherché à étudier l’effet de la stratégie SD sur la taille du stent.

Méthodes

Deux cent cinquante-huit patients pris en charge pour angioplastie primaire ont été inclus, 84 ont été traités par stratégie SD et 174 par la stratégie SI. Pour chaque patient, une séquence permettant l’analyse de la lésion avant stenting a été sélectionnée et anonymisée par un opérateur indépendant. Les séquences préalablement randomisées ont été analysées par 2 angioplasticiens afin de mesurer la lésion par Quantitative Coronary Assessment et de proposer une taille (diamètre, longueur) de stent. L’objectif principal était d’étudier la variation de dimensions des stents proposés entre les 2 coronarographies dans le groupe SD.

Résultats

Le délai médian entre 2 coronarographies était de 2jours. La stratégie SD a conduit au choix de stents plus courts (–1,64mm ; p =0,030) et plus larges (+0,13mm ; p <0,001) lors de la seconde coronarographie, essentiellement pour les artères coronaires droites.

Conclusions

La stratégie SD permet de réaliser une angioplastie avec implantation de stents plus courts et plus larges. Ceci est probablement lié à une estimation plus précise de la lésion coupable après la levée du spasme coronaire et la réduction de la charge thrombotique intra-coronaire. Cela pourrait avoir un impact clinique en termes de resténose intra-stent et de thrombose.

The full text of this article is available in PDF format.

Keywords : ST-segment elevation myocardial infarction, Myocardial infarction, Stent, Thrombus, Primary angioplasty

Mots clés : Syndrome coronarien aigu avec sus-décalage du segment ST, Infarctus du myocarde, Stent, Thrombus, Angioplastie primaire

Abbreviations : DS, IS, LAD, PCI, QCA, RVD, RCA, STEMI, TIMI


Background

During primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI), immediate stenting (IS) in a thrombus-laden coronary lesion can lead to complications, such as distal embolization, no-reflow and acute stent thrombosis [1, 2, 3]. Moreover, direct stenting may jeopardize optimal preparation of coronary lesions, which can lead to residual obstructive plaque, stent undersizing and malapposition [4, 5], and increase the risk of restenosis and stent thrombosis [6, 7, 8, 9].

In recent years, an emerging concept of deferred stenting (DS) has been proposed to minimize distal embolization into the microvasculature and, hopefully, to improve outcomes in STEMI [10, 11, 12, 13, 14, 15, 16, 17]. We have recently highlighted that in the presence of thrombolysis in myocardial infarction (TIMI) 3 flow, an important thrombotic thrombus burden identifies some patients in whom DS is of particular interest, with a decrease in risk of periprocedural events [12]. A further potential advantage of DS, in addition to the immediate protective effects, is to allow for more accurate assessment of the residual stenosis after thrombus regression and spasm release. Consequently, DS may lead to better stent sizing, with a foreseeable bigger diameter and shorter length.

The aim of this study was to investigate the effect of DS on stent sizes through a blind comparison of lesion characteristics and stent proposals between the first and the second angiogram evaluation.

Methods

This was a retrospective analysis of patients with STEMI who were referred to our centre (Croix-Rousse Hospital, Lyon, France) over a 3-year period for primary PCI within 12hours of symptom onset, with the culprit lesion in the left anterior descending (LAD), circumflex, right coronary (RCA) or left main artery. The diagnosis of STEMI comprised typical chest pain lasting>30minutes with persistent ST-segment elevation>1mm in two or more contiguous leads. Patients with left bundle branch block, stent thrombosis or previous coronary artery bypass surgery, or who had received thrombolysis were excluded. Patients were admitted directly to the catheterization laboratory in an emergency setting. A radial or femoral approach was used with a 6 Fr sheath to allow for potential thromboaspiration. An intracoronary injection of nitroglycerine was given in all patients after restoration of antegrade flow. Patients underwent an IS or DS strategy based on criteria developed in our previous work [12] (i.e. TIMI 3 flow restoration, large thrombus burden, regression of chest pain and regression of ST-segment elevation). Patients undergoing IS had only one angiogram, while those who had DS had two angiograms separated by ≥24hours, except in the case of a recurrence of ischaemic symptoms.

In accordance with French legislation, an observational study that does not change the routine management of patients does not need to be declared or submitted for approval to a research ethics board. Informed consent was obtained from all patients.

Study protocol

All patients in the DS group who had two films were included in the analysis, and constituted the main study group. Patients in the IS group (i.e. with one film) were also considered, because their films were included among the angiograms at the time of randomization, and thus prevented physicians from recognizing sequences, and they increased the number of angiograms used for the quantitative coronary analysis (QCA) quality check. Of note, the film analysis was performed a posteriori, and did not interfere with the management of the lesions or the choice of stent.

The analysis was conducted over a sequence of four steps. The variables collected by the operators are summarized in Figure 1.



Figure 1


Figure 1. 

Flow chart of lesion analysis by quantitative coronary analysis followed by stent proposals in the various angiograms for the immediate stenting (IS) and deferred stenting (DS) groups.

Zoom

Step one: run selection and randomization

For each coronary angiogram, a run with the culprit lesion was selected, anonymized and randomized by an independent physician (P. E.). The run was selected to allow for a satisfactory lesion analysis and a stent proposal. Finally, after the runs were randomized, using an informatics process, one run was studied for IS patients and two runs for DS patients.

Step two: vessel and lesion analysis

The randomized runs were analysed by QCA (Philips Xcelera, Best, Netherlands) by two independent operators (B. H. and E. C.) who were blinded to the strategy, the time-course and the patient's medical history. The reference vessel diameter (RVD) and the length of the lesion were determined by each operator and averaged for the analysis.

Step three: stent proposal

For each analysis of the culprit lesion, a stent diameter and length (based on standard dimensions provided by the manufacturers) were proposed by the two operators and averaged for analysis. Again, this led to one stent proposal for patients in the IS group and two stent proposals (one for each coronary angiogram) for patients in the DS group.

Step four: QCA quality check

To validate the accuracy of the QCA measurements, each implanted stent was measured by QCA by an independent operator (P. E.) and compared with its nominal size.

Statistical analysis

Continuous variables are expressed as mean±standard deviation (SD) or mean (95% confidence interval). Qualitative variables are expressed as absolute number and percentage. Univariate analysis was carried out using the χ2 test for qualitative data and the t -test for quantitative data. Further analyses were conducted according to quartiles of initial RVD (Q1<2.47mm; Q2 from 2.48 to 2.86mm; Q3 from 2.87 to 3.10mm; Q4>3.10mm) and of lesion length (Q1<12.98mm; Q2 from 12.99 to 16.82mm; Q3 from 16.83 to 23.71mm; Q4>23.71mm). One-way analysis of variance was used for comparison. Correlations were assessed with Spearman's test. Inter- and intraobserver reproducibilities were assessed for QCA by intraclass correlations in a subset of 15 patients selected randomly. Interobserver reproducibility was also tested using a Bland-Altman representation. A P value<0.05 was considered as statistically significant. Analyses were performed using SPSS 20.0.0 software (SPSS, Chicago, IL, USA).

Results

A total of 258 patients were included in the study, 84 in the DS group and 174 in the IS group. This led to the randomization and analysis of 342 films (2×84 for DS and 174 for IS). The clinical characteristics of the patients are summarized in Table 1. Patients in the DS group were more likely to be men, while no differences were apparent in terms of risk factors and STEMI location.

The angiographic characteristics of the patients are summarized in Table 2. The median delay between the two procedures was 2 days (interquartile range, 2 to 4 days) in the DS group.

Lesion and stent analysis

Table 3 details the RVD and stent size assessed on the two angiograms in the DS group. A non-statistically significant trend for a greater RVD was found during the second angiogram compared with the first, whereas lesion length was significantly shorter (–2.29mm, 95% confidence interval [CI]: –3.90 to –0.69; P =0.006). Accordingly, the diameter proposed for the stent was greater for the second procedure than for the first (+0.13mm, 95% CI: 0.07 to 0.20; P <0.001) and the length was shorter (–1.64mm, 95% CI: –3.11 to –0.16; P =0.030). When stratified according to quartiles of initial RVD and plaque length, it was shown that the larger the initial RVD, the smaller its variation at the secondary angiogram, but the higher the variation of plaque length (Figure 2A); in addition, Figure 2B demonstrates that the longer the plaque, the greater its variation at the secondary angiogram, with no influence on RVD. Results for stents were similar for length, but not significant for diameter (data not shown). When analysed according to arteries, the differences were mostly marked for the RCA, and were less pronounced in the other territories (Table 3).



Figure 2


Figure 2. 

Variations in reference vessel diameter (RVD) and lesion length between the two coronary angiograms, according to quartiles of initial (A) RVD and (B) lesion length.

Zoom

The delay between the two coronary angiograms correlated with RVD (r =0.434; P <0.0001), whereas no correlation was found with lesion length (r =0.103; P =0.346).

Reproducibility and accuracy of measurements

The interobserver reproducibilities of QCA for RVD and length were 0.836 (P <0.001) and 0.831 (P <0.001), respectively, while the intraobserver reproducibilities were 0.932 (P <0.001) and 0.960 (P <0.001), respectively.

Figure 3 shows the concordance of stent diameter and length measured by QCA compared with nominal dimensions. A good correlation was found for both diameter and length. Interobserver variability of stent proposals was fairly acceptable, particularly for diameter (Figure 4).



Figure 3


Figure 3. 

Correlation between nominal and quantitative coronary analysis (QCA)-determined stent diameter (left panel) and stent length (right panel).

Zoom



Figure 4


Figure 4. 

Interobserver reproducibility for stent diameter (left panel) and stent length (right panel), according to the Bland-Altman method.

Zoom

Discussion

We demonstrated, through a rigorous and blinded analysis, that postponing stenting in STEMI led to intervention in a shorter lesion and, to a lesser extent, on a larger vessel. This has consequences in terms of stent selection because it leads to the selection of a larger and shorter stent. This finding suggests that DS allows for tightly adjusting stents to the real vessel size and lesion length, avoiding stent underexpansion or malapposition.

Previous studies have underlined the safety of a DS strategy. In addition, the few studies that have been published on this topic [10, 11, 12, 13, 14, 17, 18, 19] have often reported fewer periprocedural complications. Some long-term advantages may also be observed in relation to better characterization of lesion length. Indeed, during STEMI, thrombus and spasm frequently occur, leading to underestimation of the diameter and overestimation of the length [20], which may have consequences in terms of stent selection.

To our knowledge, this study is the first blinded analysis that addresses the effect of DS on lesion characteristics and stent size. As could be expected from the pathophysiological considerations raised, a trend towards an increase in vessel diameter and a decrease in lesion length was evident. The analyses stratified according to basal vessel and plaque characteristics suggest that lesion length decreases mainly when the initial lesion is long and the vessel large. On the other hand, the most pronounced increase in RVD occurred in small vessels at the initial evaluation. Moreover, the longer the delay between the two coronary angiograms, the greater the RVD increase. Finally, it was only in the case of a large vessel and a short plaque that the characteristics of the lesions did not significantly change with time. With respect to RVD, similar findings were reported by Cristae et al. in a large cohort of patients with STEMI [21]. Previous intravascular imaging works observed significant variations in culprit vessel dimensions in STEMI patients treated with self-expanding stents [22] or DS strategy [23]; however, these were not blind analyses. Concerning lesion length, Carrick et al. [13], in DEFER-STEMI, reported a paradoxical increase in length with DS, but the study was not designed to evaluate the effect of DS on stent dimension. Furthermore, the physician who performed the analysis was not blinded to the strategy or the sequences, which creates a major bias. Moreover, no QCA measurements were performed, which is undoubtedly a limitation in terms of the accuracy and reproducibility of the results. In this respect, our study has major strengths, namely anonymization and randomization of the runs, followed by an independent analysis by QCA by two physicians blinded to the medical history and the strategy. The inclusion of patients who underwent IS reinforced the aim of preventing physicians from recognizing sequences. We used QCA to determine lesion characteristics. While this is not a perfect measurement, we believe that this tool is the most appropriate for a postponed analysis, as it is often used in studies dealing with coronary artery measurements [24, 25]. We validated our QCA measurements by measuring stent dimensions compared with nominal ones; good concordance, for both length and diameter, was found. The robustness of the methodology was also confirmed by good inter- and intraobserver reproducibility for the QCA. This makes our results more reliable than previous reports, and allows sound conclusions to be drawn.

An important question is whether these findings would apply to all STEMI lesions. One has to keep in mind that the DS strategy was selected in only one-third of the patients – those in whom thrombus burden was the most marked – as previously described by our team [12]. It is likely that in the IS group, the changes in lesion length and RVD would be less marked, although this cannot be tested. Another important aspect is whether this applies to all arteries. Our study provides a rather clear answer to this question. Indeed, the RVD increase and lesion length decrease were more important in the RCA. This may be explained by the differences in terms of histology, haemodynamics and geometry that may lead to more dystrophy and thrombus burden in the RCA than in the other territories [26, 27, 28]. These factors, either alone or in association with local flow patterns and geometry, may affect the topography of atherosclerosis and thrombus burden in the coronary artery tree.

Clinical implications

Our findings concerning lesion and vessel changes, observed after a median delay of 2 days, have expected implications in terms of stent dimensions, leading to the selection of larger and shorter stents. The fact that a trend for a greater diameter converts into a significantly greater stent diameter is probably because of available diameters, which increase in steps of 0.25 up to 0.5mm. This may have clinical implications, as it may reduce both the long-term risk of thrombosis and in-stent restenosis related to suboptimal stent sizing during the acute period. Indeed, stent thrombosis is more frequent when angioplasty is performed for STEMI [9]. An intravascular ultrasound study highlighted the fact that stent malapposition could be as high as 40% in all patients with STEMI [29]. This may be due to thrombus burden, as recently shown by optical coherence tomography [30]. In this respect, autoexpandable stents may limit this malapposition, but DS may also be an option, as suggested by Kim et al. [31]. Stent thrombosis is also favoured by low stent diameters [32]. DS led to the implantation of larger stents, which, on top of better stent apposition, may decrease the risk not only of thrombosis, but also restenosis [33] and target lesion revascularization [13]. One can question the clinical relevance of our finding in the context of two recent trials – the MIMI Study and the DANAMI 3-DEFER trial – showing no clinical benefit [17, 34]. Still, one cannot rule out the fact that a DS strategy may be beneficial in selected patients [35].

Study limitations

The two physicians who reviewed the runs may have been involved in the care of patients participating in this study. However, they were blinded to the medical history and the strategy; moreover, the anonymization and randomization of the runs, as well as the addition of numerous runs from patients treated by IS, warrant the impartiality of physicians. A more accurate measurement of lesions could have been performed by optical coherence tomography or intravascular ultrasound. However, adding routine endovascular imaging to all patients with STEMI would increase procedural time, with the risk of increasing complications in this group of potentially unstable patients. Our findings cannot be generalized to all patients with STEMI; however, we believe that in selected patients – e.g. those with a high thrombus burden – they may be of interest. Finally, this study does not address whether these changes in stent dimension translate into any clinical benefit with respect to long-term outcomes.

Conclusions

DS leads to a more accurate assessment of the residual lesion after spasm release and thrombus regression. Our study consistently shows that DS leads to an optimization of the stent dimensions (i.e. larger and shorter), especially in the RCA, which may have a clinical impact by reducing rates of stent thrombosis and restenosis. Our study provides a valuable piece of evidence when selecting a DS strategy, particularly for patients with an important thrombus burden. However, the link between our findings and clinical outcomes remains to be investigated.

Disclosure of interest

The authors declare that they have no competing interest.


Acknowledgments

Sophie Rushton-Smith, PhD (MedLink Healthcare Communications) provided editorial assistance, limited to editing and formatting, and was funded by the authors.

References

Sianos G., Papafaklis M.I., Daemen J., and al. Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction: the importance of thrombus burden J Am Coll Cardiol 2007 ;  50 : 573-583 [cross-ref]
Morishima I., Sone T., Okumura K., and al. Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction J Am Coll Cardiol 2000 ;  36 : 1202-1209 [cross-ref]
Smit J.J., van’t Hof A.W., de Boer M.J., and al. Incidence and predictors of subacute thrombosis in patients undergoing primary angioplasty for an acute myocardial infarction Thromb Haemost 2006 ;  96 : 190-195
Cook S., Eshtehardi P., Kalesan B., and al. Impact of incomplete stent apposition on long-term clinical outcome after drug-eluting stent implantation Eur Heart J 2012 ;  33 : 1334-1343 [cross-ref]
Ramcharitar S., Ligthart J., Van der Giessen W.J. Stent undersizing can result in procedure-related very late stent thrombosis J Invasive Cardiol 2007 ;  19 : E276-E277
Dirksen M.T., Vink M.A., Suttorp M.J., and al. Two year follow-up after primary PCI with a paclitaxel-eluting stent versus a bare-metal stent for acute ST-elevation myocardial infarction (the PASSION trial): a follow-up study EuroIntervention 2008 ;  4 : 64-70 [cross-ref]
Guagliumi G., Costa M.A., Sirbu V., and al. Strut coverage and late malapposition with paclitaxel-eluting stents compared with bare metal stents in acute myocardial infarction: optical coherence tomography substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial Circulation 2011 ;  123 : 274-281 [cross-ref]
Gibson C.M., de Lemos J.A., Murphy S.A., and al. Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy Circulation 2001 ;  103 : 2550-2554 [cross-ref]
Kukreja N., Onuma Y., Garcia-Garcia H.M., Daemen J., van Domburg R., Serruys P.W. The risk of stent thrombosis in patients with acute coronary syndromes treated with bare-metal and drug-eluting stents JACC Cardiovasc Interv 2009 ;  2 : 534-541 [cross-ref]
Isaaz K., Robin C., Cerisier A., and al. A new approach of primary angioplasty for ST-elevation acute myocardial infarction based on minimalist immediate mechanical intervention Coron Artery Dis 2006 ;  17 : 261-269 [cross-ref]
Pascal J., Veugeois A., Slama M., and al. Delayed stenting for ST-elevation acute myocardial infarction in daily practice: a single-centre experience Can J Cardiol 2016 ;  32 (8) : 988-995 [cross-ref]
Harbaoui B., Courand P.Y., Besnard C., Dauphin R., Cassar E., Lantelme P. Deferred vs immediate stenting in ST elevation myocardial infarction: potential interest in selected patients Presse Med 2015 ;  44 : e331-e339
Carrick D., Oldroyd K.G., McEntegart M., and al. A randomized trial of deferred stenting versus immediate stenting to prevent no- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI) J Am Coll Cardiol 2014 ;  63 : 2088-2098 [cross-ref]
Ke D., Zhong W., Fan L., Chen L. Delayed versus immediate stenting for the treatment of ST-elevation acute myocardial infarction with a high thrombus burden Coron Artery Dis 2012 ;  23 : 497-506 [cross-ref]
Kelbaek H., Engstrom T., Ahtarovski K.A., and al. Deferred stent implantation in patients with ST-segment elevation myocardial infarction: a pilot study EuroIntervention 2013 ;  8 : 1126-1133 [cross-ref]
Souteyrand G., Amabile N., Combaret N., and al. Invasive management without stents in selected acute coronary syndrome patients with a large thrombus burden: a prospective study of optical coherence tomography guided treatment decisions EuroIntervention 2015 ;  11 : 895-904 [cross-ref]
Belle L., Motreff P., Mangin L., and al. Comparison of immediate with delayed stenting using the minimalist immediate mechanical intervention approach in acute ST-segment-elevation myocardial infarction: the MIMI study Circ Cardiovasc Interv 2016 ;  9 : e003388
Cafri C., Svirsky R., Zelingher J., and al. Improved procedural results in coronary thrombosis are obtained with delayed percutaneous coronary interventions J Invasive Cardiol 2004 ;  16 : 69-71
Tang L., Zhou S.H., Hu X.Q., Fang Z.F., Shen X.Q. Effect of delayed vs immediate stent implantation on myocardial perfusion and cardiac function in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous intervention with thrombus aspiration Can J Cardiol 2011 ;  27 : 541-547 [cross-ref]
Santamore W.P., Yelton B.W., Ogilby J.D. Dynamics of coronary occlusion in the pathogenesis of myocardial infarction J Am Coll Cardiol 1991 ;  18 : 1397-1405 [cross-ref]
Cristea E., Stone G.W., Mehran R., Kirtane A.J., Brener S.J. Changes in reference vessel diameter in ST-segment elevation myocardial infarction after primary percutaneous coronary intervention: implications for appropriate stent sizing Am Heart J 2011 ;  162 : 173-177 [inter-ref]
Nakatani S., Onuma Y., Ishibashi Y., and al. Incidence and potential mechanism of resolved, persistent and newly acquired malapposition three days after implantation of self-expanding or balloon-expandable stents in a STEMI population: insights from optical coherence tomography in the APPOSITION II study EuroIntervention 2015 ;  11 : 885-894 [cross-ref]
Amabile N., Hammas S., Fradi S., and al. Intra-coronary thrombus evolution during acute coronary syndrome: regression assessment by serial optical coherence tomography analyses Eur Heart J Cardiovasc Imaging 2015 ;  16 : 433-440 [cross-ref]
Serruys P.W., Reiber J.H., Wijns W., and al. Assessment of percutaneous transluminal coronary angioplasty by quantitative coronary angiography: diameter versus densitometric area measurements Am J Cardiol 1984 ;  54 : 482-488 [cross-ref]
Reiber J.H., van der Zwet P.M., Koning G., and al. Accuracy and precision of quantitative digital coronary arteriography: observer-, short-, and medium-term variabilities Cathet Cardiovasc Diagn 1993 ;  28 : 187-198 [cross-ref]
Chatzizisis Y.S., Giannoglou G.D., Parcharidis G.E., Louridas G.E. Is left coronary system more susceptible to atherosclerosis than right? A pathophysiological insight Int J Cardiol 2007 ;  116 : 7-13 [cross-ref]
Choy J.S., Kassab G.S. Wall thickness of coronary vessels varies transmurally in the LV but not the RV: implications for local stress distribution Am J Physiol Heart Circ Physiol 2009 ;  297 : H750-H758
Heller L.I., Silver K.H., Villegas B.J., Balcom S.J., Weiner B.H. Blood flow velocity in the right coronary artery: assessment before and after angioplasty J Am Coll Cardiol 1994 ;  24 : 1012-1017 [cross-ref]
Guo N., Maehara A., Mintz G.S., and al. Incidence, mechanisms, predictors, and clinical impact of acute and late stent malapposition after primary intervention in patients with acute myocardial infarction: an intravascular ultrasound substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial Circulation 2010 ;  122 : 1077-1084 [cross-ref]
Gonzalo N., Barlis P., Serruys P.W., and al. Incomplete stent apposition and delayed tissue coverage are more frequent in drug-eluting stents implanted during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction than in drug-eluting stents implanted for stable/unstable angina: insights from optical coherence tomography JACC Cardiovasc Interv 2009 ;  2 : 445-452 [cross-ref]
Kim J.S., Fan C., Choi D., and al. Different patterns of neointimal coverage between acute coronary syndrome and stable angina after various types of drug-eluting stents implantation; 9-month follow-up optical coherence tomography study Int J Cardiol 2011 ;  146 : 341-346 [cross-ref]
Brodie B., Pokharel Y., Garg A., and al. Predictors of early, late, and very late stent thrombosis after primary percutaneous coronary intervention with bare-metal and drug-eluting stents for ST-segment elevation myocardial infarction JACC Cardiovasc Interv 2012 ;  5 : 1043-1051 [cross-ref]
Violini R., Musto C., De Felice F., and al. Maintenance of long-term clinical benefit with sirolimus-eluting stents in patients with ST-segment elevation myocardial infarction 3-year results of the SESAMI (sirolimus-eluting stent versus bare-metal stent in acute myocardial infarction) trial J Am Coll Cardiol 2010 ;  55 : 810-814 [cross-ref]
Kelbaek H., Hofsten D.E., Kober L., and al. Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): an open-label, randomised controlled trial Lancet 2016 ;  387 : 2199-2206 [cross-ref]
Harbaoui B., Motreff P., Lantelme P. Delayed versus immediate stenting during STEMI: towards a “tailored” strategy for primary PCI? Arch Cardiovasc Dis 2016 ;  109 : 373-375 [inter-ref]



© 2016  Elsevier Masson SAS. All Rights Reserved.
EM-CONSULTE.COM is registrered at the CNIL, déclaration n° 1286925.
As per the Law relating to information storage and personal integrity, you have the right to oppose (art 26 of that law), access (art 34 of that law) and rectify (art 36 of that law) your personal data. You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted.
Personal information regarding our website's visitors, including their identity, is confidential.
The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.
Close
Article Outline