Key result
Deferred stenting with tirofiban linked to an absolute ~30% reduction in STEMI distal embolization.
Why the study?
Patients with STEMI treated with primary PCI may develop distal microvascular embolization of thrombotic materials.
Does a two-stage deferred-stenting strategy with interim tirofiban infusion reduce distal embolization and myocardial injury compared to immediate stenting in STEMI patients with high thrombus burden undergoing primary PCI?
Cohort (n=20)
Does a two-stage deferred-stenting strategy with interim tirofiban infusion reduce distal embolization and myocardial injury compared to immediate stenting in STEMI patients with high thrombus burden undergoing primary PCI?
In STEMI patients with a high thrombus burden where initial balloon dilatation restores adequate flow, deferred stenting with interim tirofiban infusion may reduce distal embolization and avoid stenting in selected patients with <50% residual stenosis, though final infarct size and LVEF were similar to immediate stenting.
Answers are grounded in this paper and cite their sources.
May support deferred stenting with tirofiban in high-thrombus STEMI; leaves open confirmation in randomized trials before practice change.
Patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) may demonstrate distal microvascular embolization of thrombotic materials. We retrospectively examined 20 cases displaying extensive thrombus in the infarct-related artery (IRA), treated either with a two-step procedure, with interim tirofiban infusion, or immediate stent implantation. Distal embolization tended to be more common in the latter strategy, but, overall, the outcome was comparable. Thus, a two-staged procedure may be considered in selected cases of primary PCI associated with high thrombus burden.
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Sakellariou et al. (2021) conducted a cohort in ST-elevation myocardial infarction (STEMI) with high thrombus burden (n=20). Deferred stenting with interim tirofiban and enoxaparin vs. Immediate stent implantation during primary PCI was evaluated on Distal embolization. Deferred stenting with interim tirofiban resulted in 0% distal embolization compared to 30% (3/10) with immediate stenting in STEMI with high thrombus burden, with similar LVEF and peak troponin.
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