Role of deferred stenting in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention: A systematic review and meta‐analysis

Maria, Giovanni Luigi De; Alkhalil, Mohammad; Oikonomou, Evangelos; Wolfrum, Mathias; Choudhury, Robin P.; Banning, Adrian P.

doi:10.1111/joic.12380

Cited by 25 publications

(22 citation statements)

References 32 publications

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“…These findings were supported by a meta‐analysis of six randomized studies with 1126 patients which found decreased mortality (RR:2.55, 95%CI:1.42‐4.58, P < 0.01) at 13 month follow up in patients with multivessel disease who had staged revascularization of non‐culprit lesions as opposed to CR at the time of index procedure . However, other meta‐analyses found CR, regardless of timing as index or staged procedure, was associated with a lower risk of MACCE compared to culprit only intervention driven by lower risk of revascularization without any difference in mortality . Therefore, more randomized trials are required to investigate the impact of CR on all‐cause mortality in this population.…”

Section: Primary Pci For Stemimentioning

confidence: 81%

“…62 64 However, other meta-analyses found CR, regardless of timing as index or staged procedure, was associated with a lower risk of MACCE compared to culprit only intervention driven by lower risk of revascularization without any difference in mortality. 65,66 Therefore, more randomized trials are required to investigate the impact of CR on all-cause mortality in this population.…”

Section: Trials Of Complete Revascularizationmentioning

confidence: 99%

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Percutaneous coronary intervention: 2017 in review

Rao

Sheth

Grines

2018

J Interven Cardiology

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In an effort to keep the interventional community up-to-date with the abundant amount of new data, we have selected what we believe to be the most important publications in percutaneous coronary intervention from January 1, 2017 to 2 The overall rate of complete revascularization (CR) was 61.7%.In those patients with CR, there was no difference between CABG or PCI regarding death from any cause as well as composite of death, MI, and stroke at 5 year follow up, even at higher SYNTAX scores.However, compared to CABG with CR, PCI with incomplete revascularization put patients at a significant higher risk for similar endpoints. These studies suggest that the ability to achieve CR should be strongly considered when deciding between CABG and PCI in MVD.As we have learned from contemporary data on revascularization, certain subsets of patients have fared better with one revascularization strategy over another. An observational cohort study of multiple Swedish registries found that in patients with Type 1 diabetes and MVD, first multi-vessel revascularization with PCI was associated with higher risk of cardiac death, MI, and repeat revascularization although with similar all-cause mortality when compared to CABG. 3 This study indicates that CABG may be the preferred strategy in patients with Type 1 diabetes in need of multi-vessel revascularization, and is in agreement with earlier trials showing most of the benefit in patients treated with insulin, but not oral agents.In patients with low or intermediate SYNTAX score, PCI of unprotected left main with everolimus-eluting stents (EES) was shown to be noninferior to CABG with respect to a composite endpoint of death, stroke, and MI at 3 years in the EXCEL trial. 4 Of the 1905 patients randomized during the trial, 1788 patients were also followed for quality of life assessment to fully understand patient's perspective.

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Section: Primary Pci For Stemimentioning

confidence: 81%

Section: Trials Of Complete Revascularizationmentioning

confidence: 99%

Percutaneous coronary intervention: 2017 in review

Rao

Sheth

Grines

2018

J Interven Cardiology

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“…Еще одним вариантом кардиопротекции является ишемическое коронарное посткондиционирование, суть которого заключается в проведении серии циклических раздуваний баллона в просвете КА непосредственно после имплантации стента и восстановления [28] • Минимально инвазивная стратегия у избранных пациентов (П М) [32,33] • Ишемическое посткондиционирование (П М К) [34,35] • Механическая тромбэктомия (П М) [2] • Эксенатид, лираглутид (П) [36] • Оксид азота (П) [37] • Блокаторы кальциевых каналов (П М) [38] • Предсердный натрийуретический пептид (П) [36] • Гипотермия (П) [28] • Аденозин (П М) [39] • Прерывистая окклюзия коронарного синуса (П) [40] • Эксенатид, лираглутид (П) [36] • Предсердный натрийуретический пептид (П) [36] • Гипотермия (П) [28] • Аденозин (П М) [39] • Цилостазол (П) [42] Не рекомендовано…”

Section: анализ профилактических и лечебных тактикunclassified

“…• Дистанционное ишемическое кондиционирование (П М K) [29,30] • Блокаторы гликопротеиновых IIb/IIIa рецепторов тромбоцитов (К) [1] • Тикагрелор (К) [7] • ITF-1697, блокаторы циклооксигеназы (К) [7] • Дистанционное ишемическое кондиционирование (П М K) [29,30] • Рутинная мануальная аспирационная тромбэктомия (П М К) [41] • Рутинное применение блокаторов гликопротеиновых IIb/IIIa рецепторов тромбоцитов (П М К) [1] • Рутинное отсроченное стентирование (П М К) [33] • Интракоронарное введение фибринолитика (П) [15] • Циклоспорин А (П К) [36] • MTP-131 (П) [36] • TRO40303 (П) [36] • Ингибиторы протеинкиназы C-дельта (П) [36] • Устройства для профилактики дистальной эмболизации (П К) [2] • Оксигенация (П К) [1] • Никорандил (П М) [2] • Пекселизумаб (К) [2] • FX06 (П) [2] • Эритропоэтин (П) [2] • Эпинефрин (П) [2] • Внутриаортальная баллонная контрпульсация (П) [8] • Стволовые клетки (П М) [43] Примечание. П -проведены небольшие пилотные клинические исследования; М -выполнен метаанализ; К -проведено крупное рандомизированное клиническое исследование с оценкой твердых конечных точек; К Ппродолжается крупное клиническое исследование; Э -согласованное мнение экспертов коронарного кровотока.…”

Section: анализ профилактических и лечебных тактикunclassified

Coronary microvascular obstruction (the no-reflow phenomenon) during percutaneous coronary interventions in patients with myocardial infarction

Фролов¹,

Починка²,

Shahov³

et al. 2020

PKiK

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Coronary microvascular obstruction (the no-reflow phenomenon) after percutaneous coronary interventions in diagnosed with myocardial infarction has a significant negative impact on both the short-term and long-term prognosis. The mechanisms underlying this disorder are heterogeneous and complex, and as such it is difficult to devise effective treatments and/or to predict specific outcomes. Modern therapeutic approaches have indirect cardioprotective effects and certainly reduce the risk of no-reflow. However, attempts to create a drug or method that fundamentally improve the prognosis in patients with coronary microvascular obstruction have been unsuccessful. Thus, the problem of myocardial reperfusion damage has not been solved and further study will be necessary to provide support for the search for new therapeutic modalities. The purpose of this review is to provide an analysis of relevant literature that focuses on the aetiology, pathogenesis, diagnosis, prognosis and treatment of the coronary microvascular obstruction during and after percutaneous coronary interventions in patients diagnosed with myocardial infarction. We searched using the Medline (PubMed), RSCI (eLIBRARY), Embase and Google Scholar databases for all relevant literature pertaining to this subject.Received 13 January 2020. Accepted 11 February 2020.Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

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“…All patients should proceed urgently to the catheterization laboratory, and flow may need to be restored with a wire or gentle predilatation with a balloon. If high burden of thrombus is seen, deferred stenting with an interim period of adjunctive antiplatelet/anti thrombotic therapy may be useful to reduce the thrombus load and minimize complications (such as no-reflow) at time of stenting [47,48].…”

Section: Deferred Stentingmentioning

confidence: 99%

Management of Intracoronary Thrombus

Sathananthan

Watson²,

Overgaard

et al. 2018

Primary Angioplasty

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Partial or complete occlusion of the infarct-related artery (IRA) with intracoronary thrombus (ICT) is the pathognomonic hallmark of patients presenting with ST-elevation myocardial infarction (STEMI). Thrombus burden can be highly variable, but its presence is associated with worse outcomes, including lower procedural success, increased abrupt vessel closure and an increased frequency of major inhospital complications including death and recurrent myocardial infarction (MI). ICT poses a unique series of challenges, but appropriate management is an essential prerequisite for successful primary percutaneous coronary intervention (PPCI). This can largely be achieved using a combination of pharmacological and mechanical approaches prior to coronary stent insertion.In this chapter, we discuss the causes, sequelae and treatment of intracoronary thrombus specific to patients presenting with STEMI.

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Role of deferred stenting in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention: A systematic review and meta‐analysis

Abstract: A deferred stenting strategy could be a feasible alternative to the conventional approach with immediate stenting in "selected" STEMI patients undergoing pPCI.

Cited by 25 publications

References 32 publications

Percutaneous coronary intervention: 2017 in review

Percutaneous coronary intervention: 2017 in review

Coronary microvascular obstruction (the no-reflow phenomenon) during percutaneous coronary interventions in patients with myocardial infarction

Management of Intracoronary Thrombus

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