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Published on: January 18, 2018
Outcomes of patients with acute ST-segment elevation myocardial infarction treated by a prolonged "Deferred"
Akshyaya Pradhan1, Shivam Uppal2, Pravesh Vishwakarma3
1Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.
Insights
Deferred percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) reduces thrombus burden and improves blood flow. This safe strategy also prevents unnecessary stent placement in high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Primary percutaneous coronary intervention (PCI) is standard for ST-segment elevation myocardial infarction (STEMI).
- High thrombus burden in STEMI patients undergoing immediate PCI risks thrombus migration and no-reflow phenomena.
- Deferred stenting aims to reduce thrombus load, potentially mitigating slow-flow and no-reflow complications.
Purpose of the Study:
- To evaluate the effectiveness and safety of a deferred PCI strategy in acute STEMI patients within a real-world clinical setting.
Main Methods:
- A cohort of 55 acute STEMI patients undergoing coronary angiography were selected for a deferred PCI strategy.
- The study was conducted at King George's Medical University, Lucknow, between October 2018 and October 2019.
- Patients were chosen based on specific angiographic features indicative of high thrombus burden.
Main Results:
- Anterior wall STEMI was most common (62%), with diabetes (18.2%) and hypertension (16.2%) as primary risk factors.
- Deferred PCI demonstrated significant improvements in thrombus grade, Thrombolysis in Myocardial Infarction (TIMI) flow grade, myocardial blush grade, and reduced stenosis severity.
- The strategy proved safe, with a low incidence of slow-flow/no-reflow (7.4%) and a high rate of successful recanalization (29.3%), avoiding unnecessary stent deployment.
Conclusions:
- Deferred PCI is a safe and effective strategy for STEMI patients with high thrombus burden.
- This approach successfully reduces thrombus burden, enhances TIMI flow and myocardial blush, and prevents unwarranted stent deployment.
- Deferred stenting offers a valuable alternative to immediate stenting, improving procedural outcomes and patient safety.
Background:
Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-segment elevation myocardial infarction (STEMI). However, in patients with high thrombus burden, immediate stenting during PCI can lead to poor outcomes due to the risk of thrombus migration and subsequent microvascular occlusion, resulting in no-reflow phenomena. Deferred stenting offers a potential advantage by allowing for the reduction of thrombus load, which may help to minimize the incidence of slow-flow and no-reflow complications. This study explores the effectiveness of a deferred stenting strategy in improving outcomes for STEMI patients.
Aim:
To evaluate the effectiveness and safety of deferred PCI in a real-world setting in acute STEMI patients.
Methods:
This study was conducted at King George's Medical University, Lucknow, from October 1, 2018, to October 30, 2019 and included a total of 55 participants. Patients with acute STEMI who underwent coronary angiography were selected for a deferred PCI strategy based on specific angiographic features.
Results:
Anterior wall myocardial infarction was the predominant type of STEMI in 62% of the selected 55 patients (mean age: 54 years; 70% males), and diabetes mellitus was the most common risk factor (18.2%), followed by hypertension (16.2%). On the second angiogram of these patients measures of thrombus grade, thrombolysis in myocardial infarction flow grade, myocardial blush grade, and severity of stenosis of culprit lesion were considerably improved compared to the first angiogram, and the average culprit artery diameter had increased by 7.8%. Most patients (60%) had an uneventful hospital stay during the second angiogram and an uneventful intraprocedural course (85.19%), with slow-flow/no-reflow occurring only in 7.4% of the patients; these patients recovered after taking vasodilator drugs. In 29.3% of patients, the culprit artery was recanalized, preventing unnecessary stent deployment.
Conclusion:
Deferred PCI strategy is safe and reduces the thrombus burden, improves thrombolysis in myocardial infarction (TIMI) flow, improves myocardial blush grade, and prevents unwarranted stent deployment.
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