1. Role of Stenting in Acute MI: PAMI Stent Pilot Trial
PTCA Stent PTCA Stent
n=290 n=292 n=146 n=147
1-Month death (%) †
6-Month MACE (%)
6-Month death (%) †
6-Month TVR (%) ‡
6-Month restenosis (%) ‡
PTCA Stent PTCA Stent
n=290 n=292 n=146 n=147
1-Month death (%) †
6-Month MACE (%)
6-Month death (%) †
6-Month TVR (%) ‡
6-Month restenosis (%) ‡
TIMI 0-1 TIMI 2-3
Lecture Notes
The addition of stenting to primary angioplasty has been proposed as a means of reducing 6-month rates of restenosis and repeat target vessel revascularization (TVR), which are as high as 50% and 20%, respectively. (Lansky et al, 1999)
A report on the Primary Angioplasty in Myocardial Infarction (PAMI) Stent Pilot Trial found that patients randomized to stent-augmented primary angioplasty had a similar mortality and a lower retenosis rate at a median follow-up of 7.4 months than did patients receiving conventional primary angioplasty. (Lansky et al, 1999)
However, as shown in the slide, a subsequent report on an expanded patient population in the same PAMI trial found that the baseline differences in TIMI flow grade were associated with significantly different outcomes.
Among patients with TIMI grade 0-1 flow at baseline, stent- augmented primary angioplasty was associated with significantly more favorable 6-month rates of restenosis and TVR and no statistical advantage in the 6-month rate of major adverse cardiac events (MACE), a composite endpoint of death, reinfarction, and TVR. However, in comparison to conventional primary angioplasty
MACE, major adverse cardiac events; TVR, target vessel revascularization. †P < 0.05, ‡ P < Adapted from Lansky et al. J Am Coll Cardiol. 1999;33 (Suppl A):368A.