Key result
Deferred stenting in STEMI patients with high thrombus burden reduced angiographic events (P=0.016) but increased in-hospital MACE compared to immediate stenting (20% vs 6%; P=0.037).
Why the study?
Recent guidelines recommend against routine deferred stenting in STEMI, but whether deferred stenting in primary PCI reduces angiographic or in-hospital MACE compared to immediate stenting remained to be assessed.
Does deferred stenting reduce angiographic or in-hospital major adverse cardiac events in STEMI patients with high thrombus burden compared to immediate stenting?
RCT (n=100)
Does deferred stenting reduce angiographic or in-hospital major adverse cardiac events in STEMI patients with high thrombus burden compared to immediate stenting?
p-value: p=0.016
Deferred stenting in STEMI patients with high thrombus burden improves angiographic outcomes but worsens short-term clinical outcomes, supporting guidelines against its routine use.
Deferred stenting may increase in-hospital MACE in high-thrombus STEMI; leaves open its role pending randomized trials.
Recent guidelines recommend against deferred stenting as a routine strategy in STEMI patients. Objectives: current study aimed to assess whether deferred stenting strategy in primary PCI might reduce angiographic or in-hospital major adverse cardiac events in comparison to immediate stenting. Methods: one hundred patients of STEMI with high thrombus burden divided equally into; 50 patients (group 1) treated with immediate stenting and 50 patients (group 2) treated with deferred stenting. Procedural angiographic events were the primary endpoints, while in hospital MACE were designed as secondary endpoints. Results: patients of deferred stenting group had statistically significant reduction of distal embolization, slow flow and no reflow (P value = 0.016). In contrast, deferred strategy didn’t improve the short term clinical outcomes. Composite of MACEs was statistically significant in the deferred stenting group (20%) versus only (6%) in the immediate stenting group (P value = 0.037). Conclusion: Deferred stenting in patients with STEMI those with high thrombotic burden improves only the angiographic outcomes but could not improve the short term clinical outcomes in comparison to immediate stenting. Deferred stenting shouldn’t be used as a routine strategy in STEMI patients.
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M et al. (2019) conducted an RCT in ST segment elevation myocardial infarction with high thrombus burden (n=100). Deferred stenting vs. Immediate stenting was evaluated on Procedural angiographic events (distal embolization, slow flow and no reflow) (p=0.016). Deferred stenting in STEMI patients with high thrombus burden reduced angiographic events (P=0.016) but increased in-hospital MACE compared to immediate stenting (20% vs 6%; P=0.037).
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