Deflated Balloon-Facilitated Direct Stenting vs. Conventional Balloon Pre-Dilatation in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: A Comparative Study

Abstract

Objectives: Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy for ST-segment elevation myocardial infarction (STEMI) within 12 hours of symptom onset. This study aimed to compare the efficacy and safety of deflated balloon-facilitated direct stenting (DBDS) versus conventional balloon pre-dilatation before stenting in PPCI. Methodology: STEMI patients presenting within 12 hours of symptom onset with coronary angiography (CAG) thrombolysis in myocardial infarction (TIMI) flow <1 or no distal runoff after wire passage were included, while those with TIMI flow ≥1 or distal runoff after wire passage were excluded. A total of 160 participants (mean age 53.57 ± 11.15 years, 74.4% males) were enrolled. Patients were categorized into three groups: PPCI with DBDS (group 1, n=60), PPCI with conventional balloon pre-dilatation before stenting (group 2, n=60), and PPCI with conventional balloon pre-dilatation after three unsuccessful DBDS attempts (group 3, n=40). Results: Group 2 had a significantly lower incidence of no-reflow (p = 0.011), while group 1 demonstrated a shorter mean procedure time and required significantly less contrast volume (t(118) = −1.950, p = 0.054 and t(118) = −4.389, p < 0.001, respectively). Group 3 exhibited the highest incidence of no-reflow, the longest procedure time, and the highest contrast volume usage. Conclusion: Our findings suggest that conventional balloon pre-dilatation before stenting is associated with a lower incidence of no-reflow compared to DBDS. In PPCI, if direct stenting is not feasible due to the absence of distal runoff, balloon pre-dilatation may be a safer and more effective option than the DBDS technique.