SPC365

Invasive treatment without stenting in acute myocardial infarction: “no stent” experience in single centre

Session: Sessão de Posters 29 - Intervenção coronária percutânea
Speaker: Marta Paralta De Figueiredo

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Cartazes
FP Number: ---
Authors: Marta Paralta De Figueiredo; Miguel Carias; Rita Rocha; Diogo Brás; Gustavo Sá Mendes; Renato Fernandes; Ângela Bento; David Neves; Lino Patrício

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Percutaneous coronary intervention (PCI) is the gold standard for treatment of patients with acute coronary syndrome (ACS). However, the need and timing of stent implantation remains controversial, especially in patients with high thrombotic burden and with intermediate lesions.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Purpose:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> To characterize a population of patients admitted with an ACS, who were submitted to PCI without immediate stenting.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Retrospective analysis of patients admitted with ACS over the past 3 years at a single centre submitted to coronary angiography. We selected those treated with PCI without immediate stenting. We documented age, sex, and personal history, as well as ECG presentation, coronary anatomy and lesions. Mortality and reinfarction on follow-up were documented.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> We analysed 1974 patients, and those without immediate stenting represented 1,2% of the population (n=46 patients). Mean follow-up time was 1,43&plusmn;1,1years. They were mostly male (80,4%), with a mean age of 61,0&plusmn;13,3 years. 45,6% had history of arterial hypertension, 39,1% of dyslipidaemia, 15,2% of diabetes and 52,2% of active or previous smoking. 8,70% had history of previous ACS and 6,5% had family history of coronary disease. No patients had history of cancer or previous arrhythmias. When admitted, 67,4% presented with ST-segment elevation on admission, with the remainder being non-ST-segment elevation AMI. On angiography, the right coronary artery was the culprit lesion on 52,2% of patients, while the left coronary artery represented 39,1% and circumflex artery 8,7%. All patients presented with large thrombi on the culprit artery, with TIMI 3 flow after aspiration. 69,6% were submitted to revision angiography (either by coronary angio-CT or angiography), with deferred stenting being performed on 23,9%. We recorded 6,5% of mortality, all by non-cardiovascular causes. There were no records of reinfarction to the present date. 76,1% patients ended up not implanting any stent and all were event-free on follow-up.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusions:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> PCI with stent implantation remains the preferential option for patients with ACS, especially STEMI. However, on a subgroup of patients, no immediate stenting, with the possibility of a later re-evaluation, seems to be a safe option. This should be considered especially in the presence of a high thrombotic burden, coronary ectasia or in intermediate/non-significant lesions. On a 1.43-year mean follow-up post-ACS, there was no record of reinfarction or cardiovascular death on any patient.</span></span></span></span></p>