Key result
Deferred stenting significantly reduced one-year major adverse cardiovascular events to 7% compared to 20% with immediate stenting in late-presenting STEMI patients with high thrombus burden.
Why the study?
Late-presenting STEMI patients with a high thrombus burden face an increased risk of no reflow and adverse outcomes with immediate stenting, and optimal stent timing in this subgroup remains unclear.
Does deferred stenting improve procedural outcomes and reduce MACE at one year in late-presenting STEMI patients with high thrombus burden compared to immediate stenting?
Observational (n=200)
No
Does deferred stenting improve procedural outcomes and reduce MACE at one year in late-presenting STEMI patients with high thrombus burden compared to immediate stenting?
Absolute Event Rate: 7% vs 20%
p-value: p=0.01
In late-presenting STEMI patients with high thrombus burden, deferred stenting significantly improved myocardial perfusion and reduced one-year MACE compared to immediate stenting.
Deferred stenting was associated with better perfusion and outcomes in late STEMI with high thrombus burden; leaves open need for randomized trials before practice change.
BACKGROUND: Late-presenting patients with ST-segment elevation myocardial infarction (STEMI), defined as those presenting ≥12 hours after symptom onset, represent a high-risk and often underrepresented population. Despite evidence supporting primary percutaneous coronary intervention (PCI) in these patients, those with a high thrombus burden (HTB) face an increased risk of no reflow and adverse outcomes, particularly with immediate stenting. The optimal stent timing in this subgroup remains unclear. METHODS: This retrospective study included 200 patients with late-presenting STEMI and angiographically confirmed HTB. Patients were assigned to either the deferred stenting (DS; n=100) group or the immediate stenting (IS; n=100) group. Clinical and procedural outcomes, including myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) flow, and major adverse cardiovascular events (MACE) at one year, were compared. RESULTS: The DS group was associated with significantly lower no reflow (11 (11%) vs. 26 (26%), p=0.01), less distal embolization (6 (6%) vs. 16 (16%), p=0.04), and higher post-PCI TIMI grade 3 flow (73 (73%) vs. 57 (57%), p=0.03) and MBG 3 (58 (58%) vs. 36 (36%), p=0.01). One-year MACE was significantly reduced in the DS group (7 (7%) vs. 20 (20%), p=0.01). The DS group was independently associated with improved myocardial perfusion and lower MACE. CONCLUSION: In late-presenting STEMI patients with HTB, deferred stenting yielded superior perfusion and clinical outcomes compared to immediate stenting. These findings underscore the importance of individualized stent timing strategies in this high-risk, often overlooked subgroup.
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Ismaiel et al. (2025) conducted an observational in Late-presenting ST-segment elevation myocardial infarction (STEMI) with high thrombus burden (n=200). Deferred stenting vs. Immediate stenting was evaluated on One-year major adverse cardiovascular events (MACE) (p=0.01). Deferred stenting significantly reduced one-year major adverse cardiovascular events to 7% compared to 20% with immediate stenting in late-presenting STEMI patients with high thrombus burden.
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