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Published on: February 18, 2020
Deferred versus conventional stent implantation in patients with acute ST-segment elevation myocardial infarction: An
Joo Myung Lee1, Tae-Min Rhee2, Haseong Chang1
1Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Insights
Deferred stenting in ST-segment elevation myocardial infarction (STEMI) reduces periprocedural events but does not impact major adverse cardiac events (MACE). This approach offers procedural benefits without altering long-term clinical outcomes in primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- ST-segment elevation myocardial infarction (STEMI) management involves primary percutaneous coronary intervention (PCI).
- The optimal timing for stent implantation in infarct-related arteries remains a key clinical question.
- Evaluating deferred stenting versus immediate stent implantation is crucial for patient outcomes.
Purpose of the Study:
- To compare the safety and efficacy of deferred stenting versus immediate stent implantation in STEMI patients undergoing primary PCI.
- To analyze the impact of stenting timing on major adverse cardiac events (MACE) and periprocedural complications.
- To identify factors influencing outcomes in STEMI treatment strategies.
Main Methods:
- A meta-analysis of seven non-randomized registries and three randomized trials was performed.
- Included 2281 patients with STEMI undergoing primary PCI.
- Primary outcome was MACE (all-cause mortality, MI, TVR, cardiac hospitalization); secondary outcomes included periprocedural events and flow abnormalities.
Main Results:
- Deferred stenting significantly reduced periprocedural composite events and infarct-related artery flow abnormalities compared to immediate stenting.
- No significant difference in the risk of MACE was observed between deferred and immediate stenting groups (12.8% vs 15.0%).
- Clinical outcomes like mortality, MI, and TVR were unaffected by the timing of stent placement.
Conclusions:
- Deferred stenting in STEMI patients undergoing primary PCI lowers periprocedural risks and improves flow dynamics.
- The timing of stent placement (deferred vs. immediate) did not significantly affect MACE.
- Deferred stenting is a safe alternative with procedural advantages in STEMI management.
Background:
We sought to evaluate safety and efficacy of the deferred stenting versus immediate stent implantation of infarct-related arteries in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
Methods:
A meta-analysis using random-effects models were conducted. The primary outcome, major adverse cardiac events (MACE), was a composite of all-cause mortality, myocardial infarction (MI), any unplanned target vessel revascularization (TVR), and hospitalization due to cardiac cause. Periprocedural composite events were composed of acute re-occlusion, no-reflow/slow flow, or distal embolization.
Results:
Seven non-randomized registries and three randomized trials comparing outcomes of deferred versus immediate stenting in infarct-related arteries of 2281 STEMI patients were selected. Risk of MACE between deferred or immediate stenting did not differ significantly (rates, 12.8% vs 15.0%; pooled RR=0.68, 95% CI: 0.43-1.06; p=0.087; I2=26.8%). Deferred stenting was associated with significantly reduced risk of periprocedural composite events (rates, 5.3% vs 10.2%; pooled RR=0.36, 95% CI: 0.18-0.69; p=0.002; I2=68.0%) and flow abnormality in infarct-related arteries (rates, 3.8% vs 8.4%; pooled RR=0.29, 95% CI: 0.14-0.61; p=0.001; I2=58.1%). However, clinical outcomes including all-cause mortality, MI, or any unplanned TVR, were unaffected. Meta-regression indicated a significant relationship between prolonged total ischemic and reduced risk of MACE after deferred stenting (OR=0.994, 95% CI: 0.990-0.998; p=0.027; I2 residual 0.0%, adjusted R2=100.0%).
Conclusions:
Although deferred stenting carried significantly lower risk of periprocedural composite events and abnormal flow in patients undergoing primary PCI for STEMI, such benefits had no impact on MACE, which did not differ significantly by timing of stent placement.
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