Outcome of immediate versus delayed stenting in st-segment elevation myocardial infarction patients with high thrombus burden

Abstract

Background: The safety of deferred stenting as a technique in patients with ST segment elevation myocardial infarction (STEMI) is debatable by guidelines. This study aims to see how effective immediate stenting versus delayed stenting in lowering angiographic outcomes (no/slow reflow, distal embolization, and improved myocardial blush grade MBG) in STEMI patients.
Methods: Multi centers prospective clinical trial included 108 patients with STEMI with heavy thrombus burden. Patients were divided equally into two groups: Group (1): which included 54 patients who underwent immediate stenting and Group (2) which involved 54 patients who underwent deferred stenting. Procedural angiographic events were the primary endpoints, while the secondary endpoints were the presence of Major Adverse Cardiac Events (MACE) and bleeding complications with follow up duration for 6 months.
Results: Deferred stenting patients had a statistically significant decrease in slow flow and no reflow (P = 0.03). In addition, the defer group showed a greater increase in myocardial blush grade (MBG) than immediate stenting group (P value 0.04). Distal embolization, on the other hand, showed no statistical difference (P value 0.1), and there was no statistically significant difference between the two groups in terms of bleeding complications (P value 0.7), however there was no statistically meaningful improvement in the deferred stenting group (P value = 0.3) regarding the composite of MACEs between the two groups.
Conclusions: Deferred stenting was associated with improved immediate myocardial perfusion, less no/slow reflow, but not with a substantial decrease in MACEs at six months, as a result, direct stenting is a standard treatment option for STEMI patients.