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Published on: May 14, 2013
Deferred Versus Immediate Stenting in Patients With ST-Segment Elevation Myocardial Infarction: A Systematic Review
Jianzhong Qiao1, Lingxin Pan1, Bin Zhang1
1Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China.
Insights
Deferred stenting in ST-segment elevation myocardial infarction did not reduce no- or slow-reflow events but improved long-term left ventricular function. This strategy did not increase major adverse cardiovascular events compared to immediate stenting.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Inconsistent findings exist regarding deferred vs. immediate stenting for ST-segment elevation myocardial infarction (STEMI).
- Optimal treatment strategies for STEMI require further evaluation.
Purpose of the Study:
- To assess the optimal treatment strategy for patients with ST-segment elevation myocardial infarction.
- To compare deferred stenting versus immediate stenting in STEMI patients.
Main Methods:
- A meta-analysis was conducted searching PubMed, EMBASE, and Cochrane Library.
- Included nine studies: 1456 patients in randomized controlled trials and 719 in observational studies.
- Compared outcomes between deferred and immediate stenting strategies.
Main Results:
- No significant difference in no- or slow-reflow in randomized trials (OR 0.51, P=0.23), but significant in observational studies (OR 0.13, P<0.0001).
- Deferred stenting showed improved long-term left ventricular ejection fraction (WMD 1.90%, P=0.001).
- No significant differences in major adverse cardiovascular events, bleeding, death, MI, or TVR.
Conclusions:
- Deferred stenting did not reduce no- or slow-reflow, death, MI, or repeat revascularization compared to immediate stenting in STEMI.
- A deferred-stenting strategy demonstrated improved long-term left ventricular function.
Background:
A number of studies have evaluated the efficacy of deferred stenting vs immediate stenting in patients with ST-segment elevation myocardial infarction, but the findings were not consistent across these studies. This meta-analysis aims to assess optimal treatment strategies in patient with ST-segment elevation myocardial infarction.
Methods And Results:
We searched the PubMed, EMBASE, and the Cochrane Library for studies that assessed deferred vs immediate stenting in patients with ST-segment elevation myocardial infarction. Nine studies including 1456 patients in randomized controlled trials and 719 patients in observational studies were included in the meta-analysis. No significant differences were observed in the incidence of no- or slow-reflow between deferred stenting and immediate stenting in randomized controlled trials (odds ratio [OR] 0.51, 95%CI 0.17-1.53, P=0.23, I2=70%) but not in observational studies (OR 0.13, 95%CI 0.06-0.31, P<0.0001, I2=0%). Deferred stenting was associated with an increase in long-term left ventricular ejection fraction (weighted mean difference 1.90%, 95%CI 0.77-3.03, P=0.001, I2=0%). No significant differences were observed in the rates of major adverse cardiovascular events (OR 0.53, 95%CI 0.27-1.01, P=0.06 [randomized OR 0.98, 95%CI 0.73-1.30, P=0.87, I2=0%; nonrandomized OR 0.30, 95%CI 0.15-0.58, P=0.0004, I2=0%]), major bleeding (OR=0.1.61, 95%CI 0.70-3.69, P=0.26, I2=0%), death (OR=0.78, 95%CI 0.53-1.15, P=0.22, I2=0%), MI (OR=0.97, 95%CI 0.34-2.78, P=0.96, I2=35%) and target vessel revascularization (OR 0.97, 95%CI 0.40-2.37, P=0.95, I2=24%), between deferred and immediate stenting.
Conclusions:
Compared with immediate stenting, a deferred-stenting strategy did not reduce the occurrence of no- or slow-reflow, death, myocardial infarction, or repeat revascularization compared with immediate stenting in patients with ST-segment elevation myocardial infarction, but showed an improved left ventricular function in the long term.
