DIRECT STENTING VS PRE-DILATION: EVALUATING PROCEDURAL EFFICIENCY AND PATIENT OUTCOME
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Keywords
Coronary artery disease, percutaneous coronary intervention, direct stenting, pre-dilation, procedural efficiency, patient outcomes, fractional flow reserve, major adverse cardiac events, quality of life.
Abstract
Background: Coronary artery disease (CAD) is a leading cause of illness and death worldwide. Percutaneous coronary intervention (PCI) treats CAD, especially in multivessel cases. PCI often uses balloon angioplasty before stent placement, known as pre-dilation. Direct stenting, placing the stent without prior angioplasty, is a promising alternative. It may improve efficiency and outcomes.
Objective: This study compares direct stenting and pre-dilation in terms of procedural efficiency and patient outcomes in PCI for multivessel CAD.
Methods: Conducted at Punjab Institute of Cardiology, Pakistan in the duration from April, 2023 to March, 2024, this observational study involved 246 patients aged 40-85 years. Participants underwent PCI for multivessel CAD and were divided into direct stenting (n=123) and pre-dilation (n=123) groups. Primary outcomes measured were procedure duration and contrast volume. Secondary outcomes included fractional flow reserve (FFR) improvement, major adverse cardiac events (MACE), angina status (CCS grading), and quality of life (SAQ scores). Data were retrospectively collected from medical records and follow-up visits. Analysis used SPSS version 26.0 with paired t-tests, chi-square tests, logistic regression, and Kaplan-Meier survival analysis.
Results: Direct stenting reduced procedure time (45 vs. 60 minutes; p < 0.001) and contrast volume (150 mL vs. 200 mL; p < 0.001) compared to pre-dilation. FFR improved from 0.65 to 0.88 in the direct stenting group and from 0.63 to 0.85 in the pre-dilation group (both p < 0.001). MACE incidence was lower with direct stenting (5.6% vs. 9.0%; p = 0.03). Angina status and quality of life saw greater improvements in the direct stenting group (p < 0.001 for both).
Conclusion: Direct stenting enhances procedural efficiency and patient outcomes compared to pre-dilation in PCI for multivessel CAD. These findings support adopting direct stenting in routine practice, potentially improving patient care and reducing procedure-related costs.
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Dr Muhammad Zubair Khan
Consultant Cardiologist, Frontier Corps Teaching Hospital KPK Shahkas, Pakistan
Muhammad Zafarullah
Medical Officer, Punjab Institute of Cardiology, Pakistan
Dr Rida Mazhar
PGR Cardiology, Ch. Parvaiz Elahi Institute of Cardiology Wazirabad, Pakistan
Zaghum Abbas
MBBS, Post Graduate Resident Nephrology, Quaid-e-Azam Medical College Bahawalpur, Pakistan
Dr Sanaullah Khan
MBBS, FCPS Cardiology, Medical Officer, Cardiology Unit, Tehsil Headquarter Hospital Khwazakhela Swat, Pakistan
Dr Mahboob Ur Rehman
Associate Professor, Department of Cardiology, Cardiac Centre PIMS Islamabad, Pakistan