Key result
Deferred stent optimization in high-thrombus STEMI is linked to ~91% final stent expansion.
Why the study?
It is uncertain whether omitting post-dilatation and stent oversizing is safe and reduces distal thrombus embolization in STEMI patients with large thrombus burden.
Does deferred stent optimization improve procedural and clinical outcomes in STEMI patients with large thrombus burden?
Cohort (n=74)
No
Does deferred stent optimization improve procedural and clinical outcomes in STEMI patients with large thrombus burden?
Deferring stent optimization in STEMI patients with large thrombus burden appears safe, avoids no-reflow, and allows for successful staged optimization with favorable clinical outcomes.
Answers are grounded in this paper and cite their sources.
Deferred optimization may be safe with improved expansion in large-thrombus STEMI; leaves open confirmation by randomized trials.
OBJECTIVES: It is uncertain, if omitting post-dilatation and stent oversizing (stent optimization) is safe and may decrease the risk for distal thrombus embolization (DTE) in STEMI patients with large thrombus burden (LTB). BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) with stenting, (DTE) and flow deterioration are common and increase infarct size leading to worse outcomes. METHODS: From a prospective registry, 74 consecutive STEMI patients with LTB undergoing pPCI with stenting and intentionally deferred stent optimization were analyzed. Imaging data and outcomes up to 2 years follow-up were analyzed. RESULTS: ) and stent expansion (%) were corrected from 4.87±1.86mm to 6.82±2.36mm (p<0.05) and from 69±18% to 91±12% (p<0.001), respectively. During follow-up, 1 patient (1.4%) required target lesion revascularization and 1 (1.4%) patient succumbed from cardiovascular death. CONCLUSIONS: Among STEMI patients with LTB, deferring stent optimization in the setting of pPCI appears safe and potentially mitigates the risk of DTE. The impact of this approach on infarct size and clinical outcomes warrants further investigation in a dedicated trial.
No takes yet. Share an insight, caveat, or question.
Cioffi et al. (2023) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) with large thrombus burden (n=74). Deferred stent optimization (staged PCI) vs. Baseline (before optimization) was evaluated on Stent expansion (%) (p=<0.001). Deferring stent optimization in STEMI patients with large thrombus burden resulted in no cases of flow deterioration and significantly improved stent expansion from 69% to 91% during the staged procedure.
Synapse has enriched 10 related papers. Consider them for comparative context: