Among patients with STEMI undergoing primary PCI, pressure-optimized stent inflation resulted in significantly higher rates of successful reperfusion than conventional stenting and reduced need for postdilation, with a trend toward fewer 30-day major adverse cardiovascular events.
Key Findings
Results
Pressure-optimized stenting (POP) significantly improved the primary hierarchical reperfusion endpoint compared to conventional rapid inflation-deflation stenting.
WIN ratio of 1.42 (95% CI: 1.11-1.79; P = 0.004) favoring POP
Net WIN difference was +12.64% (95% CI: 3.69-20.98)
Primary endpoint was hierarchical reperfusion success analyzed using the Finkelstein-Schoenfeld unmatched WIN ratio
Hierarchical components included ST-segment resolution ≥70% at 90 minutes, final TIMI grade 3 flow, and absence of slow-flow/no-reflow
Results
The improvement in the primary endpoint was driven mainly by the first two hierarchical components: ST-segment resolution ≥70% and final TIMI grade 3 flow.
ST-segment resolution ≥70% net WIN difference: +5.70% (95% CI: -1.89 to 12.56)
Final TIMI grade 3 flow net WIN difference: +5.95% (95% CI: 1.80-10.00)
The confidence interval for ST-segment resolution crossed zero, indicating a non-statistically significant individual contribution
TIMI grade 3 flow contribution showed a confidence interval excluding zero
Results
Postdilation was significantly less frequent in the POP arm compared to the conventional arm.
Postdilation occurred in 213 of 326 stents (65.3%) in the POP arm vs 294 of 323 stents (91.0%) in the conventional arm
P < 0.001 for the difference between groups
POP protocol required stent inflation to ≥14 atm maintained until pressure stability, defined as no pressure drop ≥0.3 atm over 30 seconds
Results
Major adverse cardiovascular events (MACE) at 30 days showed a trend toward reduction with POP but did not reach statistical significance.
MACE (death, myocardial infarction, stent thrombosis, or stroke) occurred in 6 of 307 POP patients vs 12 of 300 conventional patients
Kaplan-Meier estimated event rates were 2.0% (95% CI: 0.4-3.5) vs 4.1% (95% CI: 1.8-6.3)
HR: 0.49 (95% CI: 0.18-1.31; P = 0.15)
Median follow-up was 30 days (IQR: 29-32)
Methods
The RAPID-POP trial was a multicenter randomized controlled trial enrolling 607 STEMI patients over approximately 13 months.
Enrollment period: September 30, 2024 to November 11, 2025
607 patients randomized 1:1: POP arm n = 307, conventional arm n = 300
Trial design included blinded endpoint assessment
Registered as NCT06430892
Methods
The POP protocol involved maintaining stent inflation to ≥14 atm until pressure stability was achieved.
Pressure stability was defined as no pressure drop ≥0.3 atm over 30 seconds
Comparator was conventional rapid inflation-deflation stenting
The rationale was to improve incomplete microvascular reperfusion, which 'remains a major challenge' during primary PCI for STEMI
What This Means
This research examines a new technique for opening blocked heart arteries during emergency heart attack treatment (primary PCI for STEMI). In the standard approach, doctors inflate a small balloon inside a stent (a metal mesh tube) briefly and then quickly deflate it. The new 'pressure-optimized' approach (POP) keeps the balloon inflated at a higher pressure until the pressure stabilizes — meaning it holds for at least 30 seconds without dropping — before deflating. The study randomly assigned 607 heart attack patients to one of these two approaches and tracked how well blood flow was restored to the heart.
The study found that the pressure-optimized approach led to significantly better blood flow restoration overall. Patients in the POP group were more likely to have good blood flow in their artery after the procedure (TIMI grade 3 flow) and showed a trend toward better resolution of the heart's electrical distress signal (ST-segment resolution on ECG). Importantly, the POP approach reduced the need for an additional step called 'postdilation' — a follow-up balloon inflation that is commonly used to improve stent placement — from 91% of cases down to 65%. At 30 days, there was a trend toward fewer serious events like death, heart attacks, stent clots, and strokes (2.0% vs 4.1%), though this difference was not statistically conclusive.
This research suggests that how long and at what pressure a stent is deployed during heart attack treatment may matter for patient outcomes. By ensuring the stent is fully and stably expanded before moving on, doctors may be able to restore blood flow more effectively and reduce the need for additional procedures. The authors note that larger and longer studies are needed to confirm whether this technique translates into meaningful reductions in serious clinical events over time.
Hakeem A, Ishaq H, Ali A, Memon F, Shah J, Ahmed I, et al.. (2026). Rapid Inflation-Deflation vs Pressure-Optimized Stenting During Primary PCI: The RAPID-POP Trial.. JACC. Cardiovascular interventions. https://doi.org/10.1016/j.jcin.2026.06.024