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Mitigating the risk of flow deterioration by deferring stent optimization in STEMI patients with large thrombus

Giacomo Maria Cioffi1,2,3, Yuan Zhi1, Mehdi Madanchi1,3

  • 1Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland.

BMC Cardiovascular Disorders
|October 12, 2023
PubMed

Insights

Deferring stent optimization in ST-segment elevation myocardial infarction (STEMI) patients with large thrombus burden (LTB) appears safe. This approach may reduce distal thrombus embolization (DTE) risk during primary percutaneous coronary intervention (pPCI).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Distal thrombus embolization (DTE) and flow deterioration are common complications in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI).
  • These complications can increase infarct size and lead to poorer patient outcomes.

Purpose of the Study:

  • To evaluate the safety and efficacy of omitting immediate stent optimization (post-dilatation and stent oversizing) in STEMI patients with large thrombus burden (LTB).
  • To determine if deferring stent optimization can reduce the risk of DTE.

Main Methods:

  • A prospective registry analysis of 74 consecutive STEMI patients with LTB undergoing pPCI with intentionally deferred stent optimization.
  • Analysis of imaging data (optical coherence tomography) and clinical outcomes up to 2 years post-procedure.

Main Results:

  • Deferred stent optimization was performed in all 74 patients, with staged optimization occurring after a median of 4 days.
  • Optical coherence tomography revealed residual under-expansion (80%) and thrombus (36%) before staged optimization.
  • No major complications, flow deterioration, or side branch occlusions occurred during deferred optimization. Significant improvements in minimal lumen area and stent expansion were observed post-optimization (p<0.05 and p<0.001, respectively).
  • Follow-up showed low rates of target lesion revascularization (1.4%) and cardiovascular death (1.4%).

Conclusions:

  • Deferring stent optimization in STEMI patients with LTB undergoing pPCI appears to be a safe strategy.
  • This approach may potentially mitigate the risk of DTE.
  • Further dedicated trials are needed to assess the impact on infarct size and long-term clinical outcomes.
Abstract

Keywords:
Myocardial infarctionNo-reflowOptical coherence tomographySTEMIStent optimization

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