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Stenting deferral in primary percutaneous coronary intervention: exploring benefits and suitable interval in heavy

Ahmed M Magdy1, Salwa R Demitry2, Hosam Hasan-Ali2

  • 1Cardiovascular Medicine, National Heart Institute, Cairo, Egypt. a_magdy82@hotmail.com.

The Egyptian Heart Journal : (EHJ) : Official Bulletin of the Egyptian Society of Cardiology
|September 9, 2021
PubMed

Insights

Deferred stenting in ST-elevation myocardial infarction (STEMI) patients with heavy thrombus burden improves outcomes. Stent deferral, compared to immediate stenting, reduces major adverse cardiac events (MACE) and enhances myocardial reperfusion.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Recent trials show routine stent deferral offers no benefit.
  • This contrasts with earlier findings, suggesting patient selection is crucial.
  • Heavy thrombus burden in STEMI may be a key factor where deferral could be beneficial.

Purpose of the Study:

  • To evaluate the efficacy of deferred stenting versus immediate stenting in STEMI patients with significant thrombus burden.
  • To compare reperfusion rates and clinical outcomes between early deferral, late deferral, and immediate stenting.

Main Methods:

  • A prospective, randomized clinical trial involving 150 STEMI patients.
  • Patients were divided into three groups: early stent deferral (A), late stent deferral (B), and immediate stenting (C).
  • Outcomes assessed included no-reflow, Final TIMI flow, myocardial blush grade (MBG), thrombus resolution, and 6-month Major Adverse Cardiac Events (MACE).

Main Results:

  • No-reflow was significantly higher in the immediate stenting group (C).
  • Final TIMI flow grade 3 and MBG grade 3 were significantly higher in deferred stenting groups (A and B) compared to immediate stenting (C).
  • Six-month MACE was significantly higher in the immediate stenting group (34.7%) compared to deferred stenting groups (14.6% and 16.3%).

Conclusions:

  • Deferred stenting is superior to immediate stenting in STEMI patients with large thrombus burden.
  • Stent deferral improves TIMI III flow, reduces 6-month MACE, and aids myocardial function restoration.
  • No significant difference in final TIMI flow or clinical outcomes was observed between early and late stent deferral groups.
Abstract

Keywords:
DeferralMyocardial infarctionNo-reflowST-segment elevationSlow-flow

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