Deferred stenting did not significantly reduce the composite endpoint of heart failure, MI, repeat revascularization, or all-cause mortality compared to immediate stenting at 42 months follow-up in STEMI patients.
Tailored, scenario-specific application of mechanical and pharmacological therapies, such as direct stenting in selected cases, is essential for managing high thrombus burden during primary PCI for STEMI.
Effect estimate: No significant difference
In ST-Elevation Myocardial Infarction (STEMI), Primary Percutaneous Coronary Intervention (PPCI) is the preferred treatment. However, High Thrombus Burden (HTB), defined by extensive thrombus in the Infarct-Related Artery (IRA), particularly with “cut-off” occlusion patterns and large vessel diameter (3.5 mm), presents a major challenge. Despite the use of effective anticoagulation, glycoprotein IIb/IIIa inhibitors, and Dual Antiplatelet Therapy (DAPT), HTB remains a significant obstacle. It is associated with complications such as no/slow reflow and distal embolization, leading to adverse cardiovascular outcomes. Accurate assessment using angiographic features and MI thrombus grading is essential before choosing a therapeutic strategy. Management options include mechanical thrombectomy, aspiration, parenteral/oral antiplatelets, intracoronary thrombolytics, and stenting approaches like direct stenting. Success depends on tailored, scenario-specific application of these therapies. This review highlights current strategies to manage HTB during PPCI.
Mody et al. (Mon,) conducted a review in Patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) with high thrombus burden (n=410). Deferred stenting vs. Immediate stenting was evaluated on Composite of heart failure, myocardial infarction, repeat revascularization, or all-cause mortality (No significant difference). Deferred stenting did not significantly reduce the composite endpoint of heart failure, MI, repeat revascularization, or all-cause mortality compared to immediate stenting at 42 months follow-up in STEMI patients.