Abstract 920: Is Balloon Angioplasty without Stent Placement Adequate for Patients in Whom Early Coronary Artery Bypass Surgery Is Planned after Primary Percutaneous Coronary Intervention?
Many patients (pts) presenting with STEMI undergo immediate mechanical reperfusion of the infarct-related artery before undergoing early CABG as a result of multivessel coronary disease and/or unsuitable coronary anatomy for multivessel PCI. Whether stent implantation is neccessary for all these pts or percutaneous balloon angioplasty with provisional stenting (primary PTCA) if required allow safe transition to subsequent early CABG is currently not known. We examined 2982 pts with STEMI enrolled in Stent-PAMI and CADILLAC trials treated with primary PTCA (n=1494) or primary stenting (n=1488). To evaluate if the strategy of primary PTCA versus primary stenting had any differences in clinical events in the first 30 days (anticipated time to early CABG), we examined these events in the 2 groups among i) all randomized pts, ii) pts with multivessel coronary artery disease and iii) pts with stent-like PTCA results (residual core laboratory diameter stenosis <30% without significant dissection). Baseline clinical features and post procedural TIMI 3 flow were similar in the 2 cohorts but post-PCI infarct vessel diameter stenosis was higher in the PTCA group. Provisional stenting was required in 16% of PTCA pts and stent-like PTCA results were acquired in 60% of pts. The need for ischemic-target vessel revascularization (iTVR) at 30 days was higher in the primary PTCA group but other 30-day events were similar in the 2 groups among all subgroups examined (table⇓). Compared to primary stenting, primary PTCA is associated with higher rates of iTVR at 30 days, but with no increase in death or reinfarction. Thus, provided surveillance is maintained for ischemic events, this strategy may be reasonable alternative option in pts needing subsequent early CABG and allows rapid reperfusion and shorter course of potent antiplatelet therapy permitting CABG earlier in majority of these pts compared with those receiving primary stents.