Stenting deferral in primary percutaneous coronary intervention: exploring benefits and suitable interval in heavy thrombus burden

Abstract

Background Deferred stenting, despite being successful in early studies, showed no benefit in recent trials. However, these trials were testing routine deferral; not in patients with heavy thrombus burden. Results This is a prospective, Randomized Clinical Trial that included 150 patients who presented with STEMI, patients were allocated into three equal groups after the coronary angiography ± primary intervention and before stenting of the culprit lesion; group (A) included 50 patients with early deferral of stenting, group (B) included 50 patients with late deferral and group (C) included 50 patients with immediate stenting. No-reflow was significantly higher in group C, while Final TIMI flow grade 3 and MBG grade 3 were significantly higher in group A and B than group C; p = 0.019 and < 0.001 respectively, with no significant difference between groups A and B, only the thrombus resolution in group B was significantly higher than group A; p < 0.001. Finally, 6-months, over-all MACE was significantly higher in group C (34.7% vs. 14.6% and 16.3%, p = 0.029). Conclusions Stent deferral was proved to be better than immediate stenting after recanalization of IRA, in achieving TIMI III flow, reducing risk of 6 months MACE, and restoration of myocardial function in a subset of STEMI patients presenting with large thrombus burden. While, no significant difference was found between both deferral times in final TIMI flow, or clinical outcomes.

Efficacy and Safety of Deferred Stenting in Geriatric Patients with STEMI and High Thrombus Burden

“…[ 39 ] reported that 150 patients with STEMI were randomly divided into three groups: early deferral group (Group A, n = 50, 4–16 h later), late deferral (Group B, n = 50, after 7 days), and immediate stenting (Group C, n = 50). For deferred stenting, the antithrombotic strategy included a continuous intravenous infusion of glycoprotein IIb/IIIa inhibitor for 48 h (irrespective of time of deferral of stenting), subcutaneous low molecular weight heparin (enoxaparin 1 mg/kg every 12 h until the 2nd procedure), and DAPT with aspirin and ticagrelor [ 39 ]. Their findings showed a significant improvement in thrombus resolution in group B (deferral 7 days) compared to group A (deferral 4–16 hours, p 0.001) along with improvements in other clinical outcomes compared to groups A and C [ 39 ].…”

“…For deferred stenting, the antithrombotic strategy included a continuous intravenous infusion of glycoprotein IIb/IIIa inhibitor for 48 h (irrespective of time of deferral of stenting), subcutaneous low molecular weight heparin (enoxaparin 1 mg/kg every 12 h until the 2nd procedure), and DAPT with aspirin and ticagrelor [ 39 ]. Their findings showed a significant improvement in thrombus resolution in group B (deferral 7 days) compared to group A (deferral 4–16 hours, p 0.001) along with improvements in other clinical outcomes compared to groups A and C [ 39 ]. Furthermore, the HORIZONS-AMI study [ 40 ] found that in STEMI patients undergoing PCI, bivalirudin reduced the risk of major bleeding and cardiac death compared to heparin.…”

The role of deferred stenting in the treatment of ST-elevation myocardial infarction: a systematic review and meta-analysis

“…Основные характеристики 17 исследований приведены в таблице [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Изучаемые исследования различались по общему количеству пациентов.…”

“…Чаще всего инфаркт-ответственной коронарной артерией в группе НСКА была передняя межжелудочковая ветвь -43,5% наравне с правой коронарной артерией -42,9%, в группе ОСКА -правая коронарная артерия (45,3%), тогда как передняя межжелудочковая ветвьв 39,2% случаев. В некоторых исследованиях [13,24] не приводится подробная информация обо всех экстрактируемых данных, но указывается, что параметры были сбалансированы между подгруппами. Среди всех исследований определенные характеристики пациентов был несбалансированы между подгруппами, что показано в таблице.…”

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

“…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].…”