Discussion
Acute ST-Segment, STEMI, Acute Myocardial Infarction, CMD, adverse cardiac events, thrombus, MUltidevice
THROMBUS, ACUTE MYOCARDIAL INFARCTION
This prospective, single-blinded, cohort study is one of the largest studies examining the relationship between PCI technique and CMD in STEMI patients. Direct stenting was associated with a lower prevalence of CMD and adverse cardiac events when compared to balloon pre-dilatation before stenting. Both aspiration thrombectomy and administration of glycoprotein IIb/IIIa inhibitors were associated with a lower prevalence of CMD. Unlike prior studies that assessed CMD during the acute phase of STEMI, we performed coronary physiology testing three months after STEMIIn this study, multivariable logistic analysis showed that direct stenting was associated with approximately fivefold lower odds of CMD compared with balloon pre-dilatation stenting (Table However, direct stenting also has limitations, including difficulty estimating the caliber of the coronary artery, which may result in inadequate stent expansion, difficulty or failure to deliver or optimally position the stent due to inadequate visualization of the lesion marginsPrevious studies investigating the relationship between PCI techniques and CMD have shown contradictory results. He and colleagues investigated the impact of stenting technique on CMD and did not find that direct stenting had any advantages over balloon predilatation. However, the authors utilized cardiac magnetic resonance (CMR) rather than invasive coronary physiology to assess CMD. Further, they performed CMR 1 week after STEMI, which may be too early to obtain a reliable assessment of coronary microcirculationA study by Scarparo and colleagues found that among STEMI patients who had a higher thrombus burden (TIMI grade flow 0–1), those who were treated with direct stenting had a lower incidence of all-cause mortality at 15 years (hazard ratio (HR) 0.65, 95% CI 0.50–0.84, The present study also revealed that aspiration thrombectomy during primary PCI was associated with an approximately fivefold decrease in the prevalence of CMD (Table The MUltidevice Thrombectomy in Acute ST-Segment Elevation Acute Myocardial Infarction trial, which was the largest randomized trial to evaluate the impact of aspiration thrombectomy on CMD, included 208 STEMI patients and assessed CMD via CMR at 3 months. The aspiration thrombectomy group had a lower prevalence of CMD (11.4% vs. 26.7%, Finally, our study revealed that administration of an intracoronary glycoprotein IIb/IIIa inhibitor (eptifibatide) during primary PCI was associated with an approximately fivefold decreased risk of CMD (Table 