Delayed vs. immediate stenting in STEMI with a high thrombus burden

Sun, Binjie; Liu, J; Yin, H; Yang, Sen; Liu, Z; Chen, T; Li, J; Guo, Chang-Jun; Jiang, Zhi-an

doi:10.1007/s00059-018-4699-x

Cited by 8 publications

(6 citation statements)

References 35 publications

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“…The study of Carrick et al [39] demonstrated that, in high-risk STEMI patients, deferred stenting is associated with fewer intraprocedural thrombotic events, higher TIMI flow grade and increased myocardial salvage compared with immediate stenting. Similarly, a recent meta-analysis including 744 patients demonstrated that a deferred stent implantation strategy was associated with improved TIMI flow grade, greater TIMI myocardial blush grade and decreased MACEs without increasing major bleeding events in STEMI patients with a high thrombus burden [40]. Besides, it has been suggested that use of intravascular imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), which ascertains the predisposing mechanical factors of ST, may be a potential adjunctive therapy for EST [41,42].Thus, it seems reasonable to consider that aggressive EST cases can benefit from a deferred PCI strategy with intra-coronary imaging after optimal medical therapy.…”

Section: Discussionmentioning

confidence: 94%

Clinical outcomes after percutaneous coronary intervention for early versus late and very late stent thrombosis: a systematic review and meta-analysis

Yang

Liu

et al. 2020

J Thromb Thrombolysis

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Whether the clinical outcomes of stent thrombosis (ST) are different when stratified by time of occurrence remains unclear. The objective of this study was to compare the short-and long-term clinical outcomes after percutaneous coronary intervention (PCI) for early stent thrombosis (EST) versus late stent thrombosis (LST) and very late stent thrombosis (VLST). We enrolled eligible studies searched from the main electronic databases (EMBASE, PubMed, Cochrane). The primary endpoints were in-hospital, 30-day, 1-year and long-term mortality. The secondary endpoints included recurrent stent thrombosis (RST) and target vessel/lesion revascularization (TVR/TLR) during hospitalization, at 30 days, at 1 year and at long-term follow-up. A total of 23 studies with 17,592 patients were included. Compared with mortality rates of the late and very late thrombosis (LST/VLST) group, in-hospital (P = 0.004), 30-day (P < 0.00001), 1-year (P < 0.00001) and long-term mortality rates (P = 0.04) were significantly higher in the EST group. The in-hospital TVR/TLR rates were similar between the EST group and the LST/VLST group. However, a higher trend in TVR/TLR rate at 30 days and a significantly higher TVR/TLR rate at 1 year (P = 0.002) as well as at long-term follow up (P = 0.009) were found in the EST group. EST patients also trended toward higher risk of RST in both short-and long-term follow-up than LST/VLST patients, although differences were not statistically significant. After PCI treatment, patients with EST have worse clinical outcomes in both short-and long-term follow-up than patients with LST/VLST. Further studies are warranted to determine the optimal treatment strategies for EST. Keywords Stent thrombosis • Outcomes • Percutaneous coronary intervention • Meta-analysis Highlights • This is the first meta-analysis to investigate the associations between the timing of ST occurrence and the clinical outcomes of ST. • Patients with EST have worse clinical outcomes in both short-and long-term follow-up than patients with LST/ VLST. • Further studies are warranted to determine the optimal treatment strategies for EST. Yi-Xing Yang and Yin Liu have contributed equally to this work.

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Section: Discussionmentioning

confidence: 94%

Clinical outcomes after percutaneous coronary intervention for early versus late and very late stent thrombosis: a systematic review and meta-analysis

Yang

Liu

et al. 2020

J Thromb Thrombolysis

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“…При этом в группе пациентов с ОСКА, где имплантация стента не выполнялась, первичные ангиографические точки по шкале TIMI и MBG были значительно лучше, чем в контрольной группе НСКА. ОШ получить лучшие показатели в группе ОСКА по сравнению с НСКА составили 3,8; (1,2-11,8) и большую частоту резолюции подъема сегмента ST на 70 и более процентов -3,7; (1,(3)(4)(5)(6)(7)(8)(9)(10)5). Важно, что результаты нашего 5-летнего наблюдения показывают относительную безопасность этой стратегии, как по частоте необходимости повторных реваскуляризаций в ИСКА, так и по частоте повторных ИМ, по частоте фатальных осложнений.…”

Section: Discussionunclassified

“…[1,5]. Помимо того, что и дилатация коронарным баллонным катетером, и имплантация стента рекомендованным давлением в сохраняющиеся тромботические массы неизбежно несут риск развития дистальной эмболизации и, как следствие, приводят к ухудшению перфузии миокарда, но и сам по себе коронарный стент в дальнейшем повышает риски развития внутрисосудистых осложнений, таких как тромбоз и рестеноз внутри стента, особенно у пациентов с массивной тромботической нагрузкой, а имплантация стента в остаточное стенотическое поражение не влияет на кардиальную смерть [4,[6][7][8][9].…”

Section: Introductionunclassified

“…Стратегия отсроченного стентирования коронарных артерий (ОСКА) при массивном коронарном тромбозе показала успешные результаты и свидетельствует о том, что в 10-40% случаев у этих пациентов отсутствует субстрат для имплантации стента [9][10][11].…”

Section: Introductionunclassified

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Strategy of delayed intervention without stent implantation in myocardial infarction with ST segment elevation caused by massive thrombosis of the infarct-related artery

Azarov,

Glezer,

Zhuravlev

et al. 2023

Evrazijskij kardiologičeskij žurnal

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Aim. TIntroduction. To evaluate in-hospital angiographic and five-year posthospital clinical outcomes of percutaneous intervention strategy without stent implantation with immediate coronary artery stenting technique in STEMI patients with massive coronary thrombosis.Material and methods. The study enrolled 116 patients with primary STEMI myocardial infarction with the signs of massive thrombosis in the lumen of the main epicardial coronary artery with TIMI thrombus grade greater than 3 after antegrade blood flow restoration. In the 1st group of delayed intervention at the primary stage the blood flow was restored by small diameter balloon inflation and/ or manual vacuum thrombus aspiration until stable TIMI grade 3 blood flow was achieved, at control CAG on day 5-6 in 36 people the stent was not implanted due to insignificance of infarct-related coronary artery stenosis (stenosis less than 50% according to QCA). Immediate stent implantation was performed in 78 patients (group 2). The primary endpoint was the incidence of adverse cardiovascular events, including total mortality, recurrent myocardial infarction, repeated revascularization of the infarct-responsive artery. Secondary endpoint: frequency of achieving optimal myocardial perfusion as measured by angiography – TIMI blood flow and Myocardial Blush Grade.Results. The median follow-up period was 47 months. The incidence of the primary end point (MACE) was 15,8% in group 1 and 23,1% in group 2, with no statistically significant difference (p=0,408). Overall mortality (10,5% and 11,7%), the rate of repeat myocardial infarction (2,6% and 5,1%), and the rate of repeat target vessel revascularization (2,6% and 6,4%) were without significant advantage between subgroups. Optimal reperfusion (TIMI-3 and Myocardial Blush Grade 2-3 after primary procedure was achieved in significantly (p=0,02) more patients in group 1 (89%) than in group 2 (69,2%) ST segment resolution ≥70% after intervention was achieved in 87% of cases in group 1 and in 64,1% of cases in group 2 (p=0,011).Conclusion. In STEMI patients with massive coronary thrombosis, the method of delayed percutaneous intervention increases the rate of achieving optimal blood flow and allows avoiding stent implantation in the infarct-related artery in 50% of cases as compared to the method of immediate stenting. Both methods have comparable hospital and five-year clinical risks.

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“…TIMI flow grading has proven a useful tool in patients with acute MI and is used routinely in clinical practice. 10,11 Because of its significant relevance to the overall outcomes, multiple investigations have focused on describing risk factors and strategies to minimize TIMI flow grades 0 to 2 following reperfusion.…”

Section: Introductionmentioning

confidence: 99%

TIMI (Thrombolysis in Myocardial Infraction) flow grade in ST Elevation Myocardial Infarction after Primary Percutaneous Intervention

Tamrakar

Rajbhandari²,

2021

Europasian J Med Sci.

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Background: Timely reperfusion, preferably by primary percutaneous intervention (PCI) has been the guiding-principle for the treatment of patients with acute ST-elevation myocardial infarction (STEMI). TIMI flow grade of the culprit lesion after the procedure have shown to have significant implication in clinical outcome. Objective: We aimed to study the relation of TIMI flow grade with the in-hospital outcome and complication among patients of STEMI.Methods: All consecutive acute STEMI patients undergoing primary PCI during the study period (January 2020 to June 2020) were analyzed for correlation between TIMI flow grade and clinical outcome during the hospital stay. Prior approval was taken from institutional review board. The study design was retrospective observational study.Result: Total of 51(55%) patients had achieved the TIMI 3 flow after the primary PCI. Number of patients achieving TIMI flow of 2,1 and 0 after the procedure were 34(37%),6(6.5%) and 2(2%). Incidence of traditional risk factors like dyslipidemia, diabetes, hypertension was higher in TIMI flow <2 . TIMI flow <2 was also associated with more adverse events namely cardiogenic shock, arrythmias, in-hospital mortality and overall major adverse cardiovascular events.Conclusion: Patients with dyslipidemia had poor TIMI flow grade during primary PCI. Similarly, patients having hypertension, diabetes mellitus and late presentation showed tendency for TIMI flow <2 . Also, the poor TIMI flow grade after primary PCI had unfavorable the clinical outcomes like increased complications and mortality. Keywords: Primary percutaneous intervention (PCI), ST elevation MI (STEMI), TIMI flow grade

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Delayed vs. immediate stenting in STEMI with a high thrombus burden

Cited by 8 publications

References 35 publications

Clinical outcomes after percutaneous coronary intervention for early versus late and very late stent thrombosis: a systematic review and meta-analysis

Clinical outcomes after percutaneous coronary intervention for early versus late and very late stent thrombosis: a systematic review and meta-analysis

Strategy of delayed intervention without stent implantation in myocardial infarction with ST segment elevation caused by massive thrombosis of the infarct-related artery

TIMI (Thrombolysis in Myocardial Infraction) flow grade in ST Elevation Myocardial Infarction after Primary Percutaneous Intervention

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