Carrick، نويسنده , , David and Oldroyd، نويسنده , , Keith G. and McEntegart، نويسنده , , Margaret and Haig، نويسنده , , Caroline and Petrie، نويسنده , , Mark C. and Eteiba، نويسنده , , Hany and Hood، نويسنده , , Stuart and Owens، نويسنده , , Colum and Watkins، نويسنده , , Stuart and Layland، نويسنده , , Jamie and Lindsay، نويسنده , , Mitchell and Peat، نويسنده , , Eileen and Rae، نويسنده , , Alan and Behan، نويسنده , , Miles and Sood، نويسنده , , Arvind and Hillis، نويسنده , , W. Stewart and Mordi، نويسنده , , Ify and Mahrous، نويسنده , , Ahmed and Ahmed، نويسنده , , Nadeem and Wilson، نويسنده , , Rebekah and Lasalle، نويسنده , , Laura and Généreux، نويسنده , , Philippe and Ford، نويسنده , , Ian M. Berry، نويسنده , , Colin، نويسنده ,
m of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
low is associated with adverse outcomes in STEMI.
as a prospective, single-center, randomized, controlled, proof-of-concept trial in reperfused STEMI patients with ≥1 risk factors for no-reflow. Randomization was to deferred stenting with an intention-to-stent 4 to 16 h later or conventional treatment with immediate stenting. The primary outcome was the incidence of no-/slow-reflow (Thrombolysis In Myocardial Infarction ≤2). Cardiac magnetic resonance imaging was performed 2 days and 6 months after myocardial infarction. Myocardial salvage was the final infarct size indexed to the initial area at risk.
STEMI patients (March 11, 2012 to November 21, 2012), 101 patients (mean age, 60 years; 69% male) were randomized (52 to the deferred stenting group, 49 to the immediate stenting). The median (interquartile range [IQR]) time to the second procedure in the deferred stenting group was 9 h (IQR: 6 to 12 h). Fewer patients in the deferred stenting group had no-/slow-reflow (14 [29%] vs. 3 [6%]; p = 0.006), no reflow (7 [14%] vs. 1 [2%]; p = 0.052) and intraprocedural thrombotic events (16 [33%] vs. 5 [10%]; p = 0.010). Thrombolysis In Myocardial Infarction coronary flow grades at the end of PCI were higher in the deferred stenting group (p = 0.018). Recurrent STEMI occurred in 2 patients in the deferred stenting group before the second procedure. Myocardial salvage index at 6 months was greater in the deferred stenting group (68 [IQR: 54% to 82%] vs. 56 [IQR: 31% to 72%]; p = 0.031].
h-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573)
Myocardial infarction , deferred stenting , No-reflow , myocardial salvage , Primary percutaneous coronary intervention