Deferred stenting did not significantly reduce the occurrence of no- or slow-reflow (OR 0.51; 95% CI 0.17-1.53; P=0.23 in RCTs) compared with immediate stenting in patients with STEMI.
Systematic Review and Meta-Analysis (n=2,175)
Does deferred stenting reduce the incidence of no- or slow-reflow compared to immediate stenting in patients with ST-segment elevation myocardial infarction?
Deferred stenting in STEMI does not reduce no-reflow, death, MI, or repeat revascularization compared to immediate stenting, but may improve long-term left ventricular function.
Effect estimate: OR 0.51 (95% CI 0.17-1.53)
p-value: p=0.23
Background A number of studies have evaluated the efficacy of deferred stenting vs immediate stenting in patients with ST ‐segment elevation myocardial infarction, but the findings were not consistent across these studies. This meta‐analysis aims to assess optimal treatment strategies in patient with ST ‐segment elevation myocardial infarction. Methods and Results We searched the PubMed, EMBASE , and the Cochrane Library for studies that assessed deferred vs immediate stenting in patients with ST ‐segment elevation myocardial infarction. Nine studies including 1456 patients in randomized controlled trials and 719 patients in observational studies were included in the meta‐analysis. No significant differences were observed in the incidence of no‐ or slow‐reflow between deferred stenting and immediate stenting in randomized controlled trials (odds ratio OR 0.51, 95%CI 0.17‐1.53, P =0.23, I 2 =70%) but not in observational studies ( OR 0.13, 95% CI 0.06‐0.31, P <0.0001, I 2 =0%). Deferred stenting was associated with an increase in long‐term left ventricular ejection fraction (weighted mean difference 1.90%, 95% CI 0.77‐3.03, P =0.001, I 2 =0%). No significant differences were observed in the rates of major adverse cardiovascular events ( OR 0.53, 95% CI 0.27‐1.01, P =0.06 randomized OR 0.98, 95% CI 0.73‐1.30, P =0.87, I 2 =0%; nonrandomized OR 0.30, 95% CI 0.15‐0.58, P =0.0004, I 2 =0%), major bleeding ( OR =0.1.61, 95% CI 0.70‐3.69, P =0.26, I 2 =0%), death ( OR =0.78, 95% CI 0.53‐1.15, P =0.22, I 2 =0%), MI ( OR =0.97, 95% CI 0.34‐2.78, P =0.96, I 2 =35%) and target vessel revascularization ( OR 0.97, 95% CI 0.40‐2.37, P =0.95, I 2 =24%), between deferred and immediate stenting. Conclusions Compared with immediate stenting, a deferred‐stenting strategy did not reduce the occurrence of no‐ or slow‐reflow, death, myocardial infarction, or repeat revascularization compared with immediate stenting in patients with ST ‐segment elevation myocardial infarction, but showed an improved left ventricular function in the long term.
Qiao et al. (Wed,) conducted a systematic review and meta-analysis in ST-segment elevation myocardial infarction (n=2,175). Deferred stenting vs. Immediate stenting was evaluated on Incidence of no- or slow-reflow in randomized controlled trials (OR 0.51, 95% CI 0.17-1.53, p=0.23). Deferred stenting did not significantly reduce the occurrence of no- or slow-reflow (OR 0.51; 95% CI 0.17-1.53; P=0.23 in RCTs) compared with immediate stenting in patients with STEMI.
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