Immediate vs. delayed stenting in acute myocardial infarction: a systematic review and meta-analysis

Freixa, Xavier; Belle, Loïc; Joseph, Lawrence; Jf, Tanguay; Souteyrand, Géraud; Pl, Lokshina; Em, Jolicoeur

doi:10.4244/eijv8i10a185

Cited by 60 publications

(35 citation statements)

References 40 publications

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“…Other clinical trials with different approaches to deferred stenting in primary PCI include MIMI (Minimal Invasive Procedure for Myocardial Infarction [NCT01360242]), PRIMACY (Primary Reperfusion Secondary Stenting Trial [NCT01542385]), and DANAMI-3 (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [NCT01435408]). Recent studies (28–31), including 3 nonrandomized case series (28–30) and a systematic review (31), support the notion that deferred stenting may be safe in appropriately selected STEMI patients.…”

Section: Discussionmentioning

confidence: 94%

A Randomized Trial of Deferred Stenting Versus Immediate Stenting to Prevent No- or Slow-Reflow in Acute ST-Segment Elevation Myocardial Infarction (DEFER-STEMI)

Carrick

Oldroyd

McEntegart

et al. 2014

Journal of the American College of Cardiology

231

152

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ObjectivesThe aim of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).BackgroundNo-reflow is associated with adverse outcomes in STEMI.MethodsThis was a prospective, single-center, randomized, controlled, proof-of-concept trial in reperfused STEMI patients with ≥1 risk factors for no-reflow. Randomization was to deferred stenting with an intention-to-stent 4 to 16 h later or conventional treatment with immediate stenting. The primary outcome was the incidence of no-/slow-reflow (Thrombolysis In Myocardial Infarction ≤2). Cardiac magnetic resonance imaging was performed 2 days and 6 months after myocardial infarction. Myocardial salvage was the final infarct size indexed to the initial area at risk.ResultsOf 411 STEMI patients (March 11, 2012 to November 21, 2012), 101 patients (mean age, 60 years; 69% male) were randomized (52 to the deferred stenting group, 49 to the immediate stenting). The median (interquartile range [IQR]) time to the second procedure in the deferred stenting group was 9 h (IQR: 6 to 12 h). Fewer patients in the deferred stenting group had no-/slow-reflow (14 [29%] vs. 3 [6%]; p = 0.006), no reflow (7 [14%] vs. 1 [2%]; p = 0.052) and intraprocedural thrombotic events (16 [33%] vs. 5 [10%]; p = 0.010). Thrombolysis In Myocardial Infarction coronary flow grades at the end of PCI were higher in the deferred stenting group (p = 0.018). Recurrent STEMI occurred in 2 patients in the deferred stenting group before the second procedure. Myocardial salvage index at 6 months was greater in the deferred stenting group (68 [IQR: 54% to 82%] vs. 56 [IQR: 31% to 72%]; p = 0.031].ConclusionsIn high-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573)

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Section: Discussionmentioning

confidence: 94%

A Randomized Trial of Deferred Stenting Versus Immediate Stenting to Prevent No- or Slow-Reflow in Acute ST-Segment Elevation Myocardial Infarction (DEFER-STEMI)

Carrick

Oldroyd

McEntegart

et al. 2014

Journal of the American College of Cardiology

231

152

View full text Add to dashboard Cite

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“…This can occur as stent implantation can dislodge athero-thrombotic debris and cause distal embolization [24]. The observation of this phenomenon has led several groups to develop a strategy of deferred stenting in selected STEMI cases [25], [26], [27]. In this strategy, flow is restored using thrombectomy and possibly balloon inflations and stenting are deferred to allow the thrombus burden to decrease over a period of hours to days.…”

Section: Discussionmentioning

confidence: 99%

Predictors and outcome of no-reflow post primary percutaneous coronary intervention for ST elevation myocardial infarction

Mazhar

Mashicharan

Farshid

2016

IJC Heart & Vasculature

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BackgroundNo-reflow (TIMI < 3) during primary PCI (PCI) for STEMI occurs in 11–41% of cases, indicates poor myocardial tissue perfusion, and is associated with a poor outcome. We aimed to determine predictors and 12 month outcomes of patients who developed no-reflow.MethodsWe analysed the PCI database of The Canberra Hospital and identified 781 patients who underwent primary PCI during 2008–2012. Follow-up at 12 months was with letter, phone call and review of hospital records.ResultsNo-reflow was observed in 189 patients (25%) at the end of the procedure. Patients with no-reflow were older (64 vs. 61 years, p = 0.03). No-reflow patients were more likely to have initial TIMI flow < 3 (89% vs. 79%, p = 0.001), thrombus score ≥ 4 (83% vs. 69%, p = 0.0001), higher use of glycoprotein IIb/IIIa inhibitors (57% vs. 48%, p = 0.03) and longer median symptom to balloon time (223 min vs. 192 min, p = 0.004). No-reflow was an independent predictor of mortality (HR 1.95, CI 1.04-3.59, p = 0.037) during 12 month follow-up. On multivariate analysis, age > 60 years, thrombus score ≥ 4 and symptom to balloon time > 360 min were independent predictors of no-reflow. In 17% of cases of no reflow, it occurred only after stent insertion.ConclusionsNo-reflow occurred in 25% of STEMI patients undergoing primary PCI and was more likely with older age, high thrombus burden and delayed presentation. No-reflow was associated with a higher risk of death at 12 month follow-up.

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“…11 We did not observe any reocclusion in our study but our patients were on intensive antiplatelet therapy, including systematic use of glycoprotein IIb/IIIa inhibitors, which is not the current recommended practice. In a review of 5 studies, Freixa et al 23 found no cases of acute coronary occlusion occurring in the interval between the initial reperfusion and stent implantation in patients assigned to DS, with an average delay of 3.7 days between procedures. However, the optimal delay between the 2 procedures in DS is still debated.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction

Belle

Motreff

Mangin

et al. 2016

Circ: Cardiovascular Interventions

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Background-Delayed stent implantation after restoration of normal epicardial flow by a minimalist immediate mechanical intervention aims to decrease the rate of distal embolization and impaired myocardial reperfusion after percutaneous coronary intervention. We sought to confirm whether a delayed stenting (DS) approach (24-48 hours) improves myocardial reperfusion, versus immediate stenting, in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods and Results-In the prospective, randomized, open-label minimalist immediate mechanical intervention (MIMI)trial, patients (n=140) with ST-segment-elevation myocardial infarction ≤12 hours were randomized to immediate stenting (n=73) or DS (n=67) after Thrombolysis In Myocardial Infarction 3 flow restoration by thrombus aspiration. Patients in the DS group underwent a second coronary arteriography for stent implantation a median of 36 hours (interquartile range 29-46) after randomization. The primary end point was microvascular obstruction (% left ventricular mass) on cardiac magnetic resonance imaging performed 5 days (interquartile range 4-6) after the first procedure. There was a nonsignificant trend toward lower microvascular obstruction in the immediate stenting group compared with DS group (1.88% versus 3.96%; P=0.051), which became significant after adjustment for the area at risk (P=0.049). Median infarct weight, left ventricular ejection fraction, and infarct size did not differ between groups. No difference in 6-month outcomes was apparent for the rate of major cardiovascular and cerebral events. Conclusions-The

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Immediate vs. delayed stenting in acute myocardial infarction: a systematic review and meta-analysis

Abstract: Delayed stent implantation is associated with better angiographic outcomes. Randomised trials are required to assess whether delayed stenting translates into better long-term cardiac outcomes.

Cited by 60 publications

References 40 publications

A Randomized Trial of Deferred Stenting Versus Immediate Stenting to Prevent No- or Slow-Reflow in Acute ST-Segment Elevation Myocardial Infarction (DEFER-STEMI)

A Randomized Trial of Deferred Stenting Versus Immediate Stenting to Prevent No- or Slow-Reflow in Acute ST-Segment Elevation Myocardial Infarction (DEFER-STEMI)

Predictors and outcome of no-reflow post primary percutaneous coronary intervention for ST elevation myocardial infarction

Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction

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