This multicenter RCT (RAPID-POP; n=607) compared pressure-optimized stenting (POP — inflation to ≥14 atm held until pressure stability) vs. conventional rapid inflation-deflation stenting in STEMI patients undergoing primary PCI, with a primary hierarchical endpoint of reperfusion success at 90 minutes and 30-day MACE follow-up.
POP significantly improved the hierarchical reperfusion endpoint (WIN ratio 1.42; 95% CI 1.11–1.79; P=0.004), driven by higher ST-segment resolution ≥70% (+5.70%) and TIMI 3 flow rates (+5.95%), with far less need for postdilation (65.3% vs. 91.0%; P<0.001). Thirty-day MACE trended lower with POP (2.0% vs. 4.1%; HR 0.49; P=0.15) but did not reach significance.
- Short follow-up (median 30 days) limits assessment of longer-term clinical outcomes such as mortality or target vessel failure. - The MACE reduction was numerically large but underpowered to reach statistical significance (P=0.15), so clinical benefit remains uncertain. - Blinding was at the endpoint assessment level only; operators were unblinded, introducing potential performance bias.
In STEMI patients undergoing primary PCI, maintaining stent inflation pressure ≥14 atm until pressure stabilizes improves reperfusion success and reduces the need for postdilation compared to rapid deflation — consider adopting POP as a default technique while awaiting larger trials to confirm MACE benefit.
