Post‐Dilatation and Risk of Complications in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Retrospective Cohort Analysis

BACKGROUND: Post-dilatation with a noncompliant (NC) balloon is generally associated with better expansion and apposition of stent struts, leading to improved immediate angiographic results and clinical outcomes. However, some studies have raised uncertainty about its utility, suggesting a potential aggravation of microvascular obstruction and vessel wall injury. Therefore, this study aimed to investigate the impact of post-dilatation on the incidence of complications in STEMI (ST elevation myocardial infarction) patients undergoing primary percutaneous coronary intervention (PCI). METHODS: In this retrospective cohort study, we included consecutive adult STEMI patients (age ≥ 18 years) who underwent primary PCI between October 2022 and December 2024. Patients were categorized into two groups based on post-dilatation status after stent deployment. The post-dilatation and non-post-dilatation groups were compared for complications and immediate outcomes, including mortality, cardiac arrest, cardiogenic shock, heart failure, stroke, and stent thrombosis. RESULTS: The study sample consisted of 12,608 STEMI patients who underwent primary PCI, of whom 10,081 (80%) were male. The mean age was 55.8 ± 10.8 years. Post-dilatation with an NC balloon was documented in 7935 (62.9%) patients. The analysis of matched cohorts revealed, a 4.3% lower risk of cardiac arrest (risk ratio [RR]; 0.957 [95% CI: 0.945-0.97; p < 0.001]), 1.3% lower risk of cardiogenic shock (RR; 0.987 [95% CI: 0.979-0.996; p = 0.003]), 0.9% lower risk of heart failure (RR; 0.991 [95% CI: 0.984-0.997; p = 0.005]), and 4.8% lower risk of in-hospital mortality (RR; 0.952 [95% CI: 0.939-0.966; p < 0.001]) among post-dilatation as compared to non-post-dilatation cohorts. CONCLUSIONS: Post-dilatation with an NC balloon after stent deployment in patients undergoing primary PCI is associated with improved clinical outcomes and lower rates of post-procedure complications and in-hospital adverse outcomes.