COMPARING OUTCOMES OF DIRECT STENTING VS PREDILATION IN PERCUTANEOUS CORONARY INTERVENTIONS

Abstract

Percutaneous coronary intervention (PCI) is a widely used treatment for coronary artery disease. While direct stenting and predilation are commonly practiced techniques in PCI, their comparative efficacy and outcomes need further investigation to guide optimal treatment strategies. Objective: To compare the outcomes of direct stenting versus predilation in patients undergoing percutaneous coronary interventions (PCI). Methods: This randomized controlled trial (RCT) was conducted at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan, from August 2023 to January 2024, following ethical approval. One hundred fifty patients undergoing PCI were enrolled and randomly assigned into Group A (Direct Stenting) and Group B (Predilation). Group A received PCI with direct stent placement, while Group B underwent PCI with balloon predilation before stent deployment. Patients were followed up at one month and six months post-PCI for major adverse cardiovascular events (MACE), including death, myocardial infarction, target vessel revascularization (TVR), and stent thrombosis. Angiographic follow-up was performed as clinically indicated at six months. Data were analyzed using SPSS Version 25. Results: 150 patients participated, with a mean age of 50.25 ± 10.14 years. The Direct Stenting group had a shorter mean hospital stay (2.04 ± 0.44 days) than the Predilation group (3.08 ± 0.56 days). Gender distribution showed a higher percentage of males in the Direct Stenting group (54.7%) and more females in the Predilation group (60.0%). The Direct Stenting group demonstrated a lower incidence of MACE (5.3% vs. 12.0%) than the Predilation group. The rates of myocardial infarction, TVR, stent thrombosis, and complications such as coronary dissection and distal embolization were comparable between both groups. Mortality rates were identical at 1.3% in both groups. Conclusion: Both direct stenting and predilation are effective strategies in PCI, with direct stenting showing a slight advantage in reducing MACE and hospital stay. However, further large-scale randomized trials are required to define better the optimal use of these techniques across diverse patient populations and lesion types, ultimately improving patient outcomes.