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Published on: May 14, 2013
A randomized trial of deferred stenting versus immediate stenting to prevent no- or slow-reflow in acute ST-segment
David Carrick1, Keith G Oldroyd2, Margaret McEntegart3
1BHF Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom; West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Dunbartonshire, United Kingdom.
Insights
Deferred stenting in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction significantly reduced no-reflow events. This approach also enhanced myocardial salvage, improving outcomes for high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- No-reflow phenomenon is a known complication of ST-segment elevation myocardial infarction (STEMI) treatment.
- No-reflow is associated with poor clinical outcomes in STEMI patients.
Purpose of the Study:
- To evaluate if deferred stenting reduces no-reflow and improves myocardial salvage in primary percutaneous coronary intervention (PCI) for STEMI.
- To assess the efficacy of a delayed stenting strategy compared to immediate stenting.
Main Methods:
- Prospective, single-center, randomized controlled trial.
- STEMI patients with no-reflow risk factors were randomized to deferred stenting (4-16h later) or immediate stenting.
- Primary outcome: no-/slow-reflow (TIMI ≤2). Secondary outcomes: myocardial salvage via MRI.
Main Results:
- Deferred stenting group showed significantly lower incidence of no-/slow-reflow (29% vs 6%, p=0.006).
- Higher Thrombolysis In Myocardial Infarction coronary flow grades were observed in the deferred stenting group (p=0.018).
- Greater myocardial salvage index at 6 months in the deferred stenting group (68% vs 56%, p=0.031).
Conclusions:
- Deferred stenting is effective in reducing no-reflow in primary PCI for high-risk STEMI patients.
- This strategy improves myocardial salvage, indicating better heart muscle preservation.
- Deferred stenting offers a promising alternative to immediate stenting in select STEMI cases.
Objectives:
The aim of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
Background:
No-reflow is associated with adverse outcomes in STEMI.
Methods:
This was a prospective, single-center, randomized, controlled, proof-of-concept trial in reperfused STEMI patients with ≥1 risk factors for no-reflow. Randomization was to deferred stenting with an intention-to-stent 4 to 16 h later or conventional treatment with immediate stenting. The primary outcome was the incidence of no-/slow-reflow (Thrombolysis In Myocardial Infarction ≤2). Cardiac magnetic resonance imaging was performed 2 days and 6 months after myocardial infarction. Myocardial salvage was the final infarct size indexed to the initial area at risk.
Results:
Of 411 STEMI patients (March 11, 2012 to November 21, 2012), 101 patients (mean age, 60 years; 69% male) were randomized (52 to the deferred stenting group, 49 to the immediate stenting). The median (interquartile range [IQR]) time to the second procedure in the deferred stenting group was 9 h (IQR: 6 to 12 h). Fewer patients in the deferred stenting group had no-/slow-reflow (14 [29%] vs. 3 [6%]; p = 0.006), no reflow (7 [14%] vs. 1 [2%]; p = 0.052) and intraprocedural thrombotic events (16 [33%] vs. 5 [10%]; p = 0.010). Thrombolysis In Myocardial Infarction coronary flow grades at the end of PCI were higher in the deferred stenting group (p = 0.018). Recurrent STEMI occurred in 2 patients in the deferred stenting group before the second procedure. Myocardial salvage index at 6 months was greater in the deferred stenting group (68 [IQR: 54% to 82%] vs. 56 [IQR: 31% to 72%]; p = 0.031].
Conclusions:
In high-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573).
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