Deferred stenting with triple antithrombotic therapy reduced 6-month MACE compared to immediate stenting (17.1% vs 41.7%, P=0.026) in STEMI patients with high thrombus burden.
RCT (n=95)
randomized
No
Does deferred stenting with triple antithrombotic therapy including apixaban reduce 6-month MACE compared to immediate stenting in STEMI patients with high thrombus burden undergoing primary PCI?
In STEMI patients with high thrombus burden, deferred stenting combined with triple antithrombotic therapy including apixaban significantly reduces 6-month MACE and improves reperfusion and myocardial recovery compared to immediate stenting.
Absolute Event Rate: 17.1% vs 41.7%
p-value: p=0.026
Objectives: Patients with ST-segment elevation myocardial infarction (STEMI) and high thrombus burden are at increased risk of distal embolization and adverse outcomes. The best interventional approach remains uncertain. This study evaluated echocardiographic and angiographic predictors of major adverse cardiovascular events (MACE) and compared immediate versus deferred stenting combined with antithrombotic therapy. Patients and methods: In this single-center randomized trial, 95 STEMI patients with high thrombus burden thrombolysis in myocardial infarction (TIMI) grade 4–5 undergoing primary percutaneous coronary intervention were randomized to immediate stenting (n = 60) or deferred stenting with triple antithrombotic therapy including Apixaban (n = 35). Angiographic outcomes (TIMI flow, myocardial blush grade) and echocardiographic parameters, including three-dimensional speckle-tracking analysis, were assessed at baseline and 6 months. The primary endpoint was 6-month MACE (death, reinfarction, stroke, heart failure, arrhythmia, or revascularization). Logistic regression and receiver-operating characteristic analysis identified independent predictors. Results: Deferred stenting achieved higher rates of TIMI III flow (94 vs. 60%, P < 0.001) and myocardial blush grade 3 (89 vs. 42%, P < 0.001). Echocardiography showed greater improvement in left ventricular ejection fraction (LVEF) (59.1 vs. 57.0%, P = 0.021) and global longitudinal strain (–19.5 vs. –18.7%, P = 0.033). MACE occurred in 17.1% of deferred patients versus 41.7% with immediate stenting (P = 0.026). Independent predictors were lower baseline LVEF (OR 0.72, 95% CI 0.56–0.92; P = 0.008) and smaller EF improvement at follow-up (OR 0.80, 95% CI 0.69–0.91; P = 0.001). Receiver-operating characteristic analysis identified thresholds of baseline LVEF less than or equal to 44.5% and EF improvement less than or equal to 13.25%. Conclusions: In STEMI with high thrombus burden, deferred stenting improves reperfusion, enhances recovery, and lowers MACE. Echocardiographic parameters aid risk stratification and individualized management.
Samour et al. (Sun,) conducted a rct in ST-segment elevation myocardial infarction (STEMI) with high thrombus burden (n=95). Deferred stenting with triple antithrombotic therapy including Apixaban vs. Immediate stenting was evaluated on 6-month MACE (death, reinfarction, stroke, heart failure, arrhythmia, or revascularization) (p=0.026). Deferred stenting with triple antithrombotic therapy reduced 6-month MACE compared to immediate stenting (17.1% vs 41.7%, P=0.026) in STEMI patients with high thrombus burden.