• Thomas Cuisset, Michalis Hamilos, Narbeh Melikian, Eric Wyffels, Jaydeep Sarma, Giovanna Sarno, Emanuele Barbato, Jozef Bartunek, William Wijns, and Bernard De Bruyne.
• Cardiovascular Center, OLV Hospital, Aalst, Belgium.
• J. Am. Coll. Cardiol. 2008 Mar 18; 51 (11): 1060-5.

ObjectivesWe conducted a randomized study to compare the effect of direct stenting (DS) and conventional stenting (CS) on post-procedural index of microcirculatory resistance (IMR) values.BackgroundDirect stenting has been suggested to reduce periprocedural microcirculatory injury compared with stenting that follows pre-dilation (CS). The index of microcirculatory resistance is a sensitive invasive marker of coronary microvascular resistance.MethodsFifty patients admitted for elective percutaneous coronary intervention (PCI) were included. All patients had stable angina (Canadian Cardiovascular Society class ResultsAfter otherwise-uneventful PCI, patients treated with CS had significantly greater IMR (DS 13 +/- 3, CS 24 +/- 14; p < 0.01) and tended to have greater post-PCI troponin T values (DS 0.035 +/- 0.04, CS 0.17 +/- 0.02; p = 0.07). In the whole sample, 20% of patients had post-PCI troponin release (troponin T >0.03 ng/ml). Patients with troponin elevation had significantly greater post-PCI IMR values than patients without troponin elevation: 24.7 +/- 13.2 versus 16.9 +/- 10.2; p = 0.04.ConclusionsIn patients undergoing successful coronary stenting for stable angina, DS is associated with reduced microvascular dysfunction induced by PCI as compared with CS.

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