Original Studies Primary Stenting in Acute Myocardial Infarction: A 30-Day Follow Up Study Upendra Kaul, 1 * MD, DM, Balbir Singh, 1 MD, DM, Dinesh Sudan, 1 MD, DM, Rakesh Sapra, 1 MD, DM, Ram Dev Yadav, 1 MD, DM, Tapan Ghose, 1 MD, DNB, and N.S. Dixit, 1 MD, FRCP Primary coronary stenting is being increasingly used in patients undergoing primary coronary angioplasty for acute myocardial infarction. In this prospective study we evaluated our experience of direct angioplasty in 68 patients with acute myocardial infarction of whom 57 received intracoronary stents using high-pressure deployment (H12 atmospheres) with adjunct aspirin and ticlopidine therapy without coumadin. All patients underwent pre-discharge follow-up angiography. Stent implantation was success- ful in all patients. Stent thrombosis was not seen in any patient. However, TIMI grade 3 flow was obtained in only 51 patients (89.6%) with evidence of slow flow present in remaining six patients. Follow-up angiograms showed no stent thrombosis but five out of the six patients (83%) with slow-flow phenomenon persisted to have slow flow. These patients had lower left ventricular ejection fraction as compared to patients with TIMI 3 flow at follow-up angiography (27.5  10.2% vs. 42.1  15.2%, P F .001) and a high mortality (two out of six) within 30 days. Primary stenting is safe and feasible in the majority of patients with good short-term outcomes, but persistent slow-flow phenom- enon with adverse clinical outcome is seen in a small but significant number of patients. Cathet. Cardiovasc. Intervent. 46:4–10, 1999.  1999 Wiley-Liss, Inc. Key words: stenting; slow-flow phenomenon. primary coronary angioplasty INTRODUCTION Although intravenous thrombolysis is widely used as a standard therapy for patients presenting with acute myo- cardial infarction (AMI), primary percutaneous translumi- nal coronary angioplasty (PTCA) is being used with increasing frequency in this situation [1–5]. Abrupt closure and threatening vessel occlusion complicates PTCA in 2–10% of patients in this setting [5,6]. Primary stenting in AMI has been shown to be feasible with gratifying short-term result in recent studies [7–9]. In this report we present our experience of primary stenting in managing AMI. MATERIALS AND METHODS The following patient entry criteria were used. Consecu- tive patients of any age with chest pain 12 hours in duration with electrocardiographic change of ST-segment elevation in 2 contiguous leads were included. Patients with previous bypass surgery and those in cardiogenic shock (systolic blood pressure 80 mm Hg for 30 min not responsive to fluids) were excluded. Patients were also excluded if they had previously received thrombo- lytic therapy during the same period. Study Protocol Patients were treated in the emergency room with 325 mg of chewable aspirin, 500 mg of oral ticlopidine, and 5,000-unit bolus of intravenous heparin. Patients were then transferred immediately to the cardiac catheteriza- tion laboratory, and coronary arteriography was per- formed. Ionic contrast medium (Diatrizoate-Meglumine and Diatrizoate-Sodium Injection) was used in all the instances. PTCA was then performed if appropriate. Medical treatment was instituted if thrombolysis in 1 Department of Interventional Cardiology, Batra Heart Centre, Batra Hospital & Medical Research Centre, New Delhi, India. *Correspondence to: Prof. Upendra Kaul, Director Interventional Cardiology & Cardiac Electrophysiology, Batra Hospital & Medical Research Centre, 1, Tughlakabad Institutional Area, Mehrauli Badarpur Road, New Delhi-110 062, India. Received 24 May 1998; Revision accepted 30 July 1998 Catheterization and Cardiovascular Interventions 46:4–10 (1999)  1999 Wiley-Liss, Inc.