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Deferred versus Immediate Stenting in ST-segment Elevation Myocardial Infarction Patients with High Thrombus Burden:
Ahmed Saeid Eldamanhory1, Hesham Hafez Abdelkhalek Mosa1, Mahmoud Elsaid Soliman1
1Department of Cardiovascular Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Insights
Deferred stenting in ST-segment elevation myocardial infarction (STEMI) with high thrombus burden improves reperfusion and left ventricular function recovery. This approach is a feasible strategy for optimizing myocardial reperfusion.
Area of Science:
- Cardiology
- Interventional Cardiology
- Echocardiography
Background:
- Optimal timing for stent implantation in ST-elevation myocardial infarction (STEMI) with high thrombus burden is debated.
- Immediate stenting risks distal embolization and no-reflow, while deferred stenting may enhance microvascular recovery.
Purpose of the Study:
- To compare angiographic and echocardiographic outcomes of immediate versus deferred stenting in STEMI patients with high thrombus burden.
- To evaluate the efficacy of three-dimensional speckle tracking echocardiography (3D-STE) in assessing these outcomes.
Main Methods:
- A randomized clinical trial involving 115 STEMI patients with high thrombus burden.
- Patients were assigned to immediate stenting (n=60) or deferred stenting (n=55) after dual antiplatelet therapy and enoxaparin.
- Primary endpoints included final thrombolysis in myocardial infarction (TIMI) flow, myocardial blush grade (MBG), and left ventricular ejection fraction (LVEF) assessed by 3D-STE.
Main Results:
- Deferred stenting resulted in significantly higher TIMI III flow (76.4% vs. 60.0%) and MBG 3 (63.6% vs. 41.7%).
- Both groups showed improved LVEF at 6 months, with significantly greater gains in the deferred stenting group (14.05% vs. 12.89%).
- Major adverse cardiovascular events (MACE) rates were similar between the groups at 6 months (34.5% vs. 41.7%).
Conclusions:
- Deferred stenting in STEMI patients with high thrombus burden enhances angiographic reperfusion and improves left ventricular function recovery.
- This strategy is feasible for optimizing myocardial reperfusion.
- Larger, long-term trials are warranted to assess the prognostic impact of deferred stenting.
Objectives:
The optimal timing of stent implantation in ST-segment elevation myocardial infarction (STEMI) with high thrombus burden remains uncertain. Immediate stenting carries a risk of distal embolization and no-reflow, whereas deferred stenting may facilitate improved microvascular recovery. This study compared angiographic and echocardiographic outcomes of immediate versus deferred stenting using three-dimensional speckle tracking echocardiography (3D-STE).
Materials And Methods:
In this randomized clinical trial, 115 STEMI patients with high thrombus burden were allocated to immediate stenting (n = 60) or deferred stenting after dual antiplatelet therapy plus enoxaparin (n = 55). Primary endpoints were final thrombolysis in myocardial infarction (TIMI) flow, myocardial blush grade (MBG), and left ventricular ejection fraction (LVEF) by 3D-STE. Secondary endpoints included global strain parameters and major adverse cardiovascular events (MACE) at 6 months.
Results:
Deferred stenting achieved higher TIMI III flow (76.4% vs. 60.0%, P < 0.001) and MBG 3 (63.6% vs. 41.7%, P = 0.0025). Both groups showed improved LVEF at 6 months, with greater gains in the deferred group (EF change: 14.05% vs. 12.89%, P = 0.043). Favorable but nonsignificant trends were noted in global longitudinal, circumferential, and radial strain. MACE rates were similar between groups (34.5% vs. 41.7%, P = 0.45).
Conclusions:
Deferred stenting in STEMI patients with high thrombus burden enhanced angiographic reperfusion and improved recovery of left ventricular function without reducing short-term MACE. These findings suggest deferred stenting as a feasible strategy to optimize myocardial reperfusion, warranting larger, long-term trials to evaluate its prognostic impact.
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