Effects of deferred versus immediate stenting on left ventricular function in patients with ST elevation myocardial
Hyungdon Kook1, Hyun-Jong Lee2, Mi-Na Kim3
1Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Insights
Deferred stenting (DS) improved left ventricular (LV) diastolic function in ST-elevation myocardial infarction (STEMI) patients, but not systolic function, compared to immediate stenting (IS). Clinical outcomes showed a trend towards fewer major adverse cardiac events with DS.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Conflicting data exists on deferred stenting (DS) benefits in ST-elevation myocardial infarction (STEMI).
- The impact of DS on left ventricular (LV) function post-STEMI remains unclear.
- The INNOVATION study (NCT02324348) investigated DS versus immediate stenting (IS).
Purpose of the Study:
- To evaluate if DS improves LV function and clinical outcomes after STEMI.
- To compare LV functional remodeling and major adverse cardiac events (MACE) between DS and IS groups.
- To analyze echocardiographic data and MACE at 1-year follow-up.
Main Methods:
- 114 STEMI patients were randomized 1:1 to DS or IS.
- LV functional remodeling indices and MACE were assessed.
- Serial echocardiography was performed, with 78% completing follow-up.
Main Results:
- No significant difference in LV volume changes between groups.
- Both DS and IS groups showed improvements in LV ejection fraction and wall motion score index, without significant inter-group differences.
- DS group demonstrated significant improvements in E/e'' and e', indicating enhanced diastolic function, unlike the IS group.
- Major adverse cardiac events were numerically lower in the DS group at 1-year follow-up, but this difference was not statistically significant.
Conclusions:
- Deferred stenting (DS) improves left ventricular (LV) diastolic function in STEMI patients compared to immediate stenting (IS).
- DS did not show significant benefits over IS in improving LV systolic function.
- DS may offer a trend towards better clinical outcomes, warranting further investigation.
Background:
Previous studies have shown conflicting results on the benefits of deferred stenting (DS) in infarct size and the incidence of microvascular obstruction in patients with ST elevation myocardial infarction (STEMI). However, effect of DS on left ventricular (LV) function was not known. We aimed to evaluate whether DS improve LV function and relevant clinical outcomes after STEMI, using follow-up data from the INNOVATION study (NCT02324348).
Methods:
In total, 114 patients were randomly assigned to DS group or immediate stenting (IS) group at a 1:1 ratio. LV functional remodeling indices and MACE (major adverse cardiac events: a composite of death, non-fatal MI, unplanned target vessel revascularization, or hospitalization due to heart failure) were compared between DS and IS groups.
Results:
Serial echocardiographic analyses were completed in 89 subjects (78%). There were no significant changes in LV volume in either group. While LV ejection fraction and wall motion score index (WMSI) improved in both groups during follow-up, the increments were not statistically different between the 2 groups (4.3 ± 8.2 vs 3.2 ± 7.1, P = .504 for ΔLV ejection fraction; -0.16 ± 0.25 vs -0.16 ± 0.25, P = .99 for ΔWMSI). However, E/e'' was decreased and e' was increased only in the DS group (-3.31 ± 5.60 vs -0.46 ± 3.10, P = .005 for ΔE/e'; 0.77 ± 1.71 vs -0.22 ± 1.64, P = .009 for Δe'). The incidence of major adverse cardiac events was numerically lower in the DS group than in the IS group without a statistical significance at 1-year follow-up.
Conclusions:
Routine DS improved LV diastolic function but not systolic function compared with IS in patients with STEMI.
More Related Videos
Related Concept Videos
01:22Mitral Stenosis I: Introduction
01:30Acute Coronary Syndrome I: Introduction