Natural History and Clinical Outcomes After ST-Segment Elevation Myocardial Infarction Without Stent Insertion.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Acute Coronary Syndromes

Background:

• ST-segment elevation myocardial infarction (STEMI) management after reperfusion can be complex when discrete severe stenotic lesions are not apparent.
• The optimal strategy between drug-eluting stent (DES) insertion and initial medical management remains debated in such cases.

Purpose of the Study:

• To evaluate short-term clinical outcomes of STEMI patients managed without initial stenting compared to those receiving DES.
• To determine if a strategy of no initial stenting impacts mortality and major adverse cardiac events.

Main Methods:

• Prospective enrollment of STEMI patients undergoing percutaneous coronary intervention between 2014-2020.
• Exclusion of patients with in-stent restenosis, stent thrombosis, or hospital mortality.
• Comparison of baseline characteristics and 30-day outcomes between patients treated with and without initial stenting, including propensity matching.

Main Results:

• A small proportion (3.3%) of STEMI patients were treated without initial stenting.
• These patients were older, with higher rates of diabetes and prior revascularization.
• No stenting was associated with significantly higher 30-day mortality, myocardial infarction, and major adverse cardiac events compared to DES insertion.

Conclusions:

• An initial strategy of no stenting in STEMI patients without severe stenosis is linked to increased 30-day mortality.
• Current-generation DES insertion should be considered when clinically appropriate for STEMI patients.
• This study supports the use of DES in selected STEMI cases to improve short-term clinical outcomes.