Author/Authors :
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 ,
Abstract :
Objectives
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).
ound
low is associated with adverse outcomes in STEMI.
s
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.
s
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].
sions
h-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573)
Keywords :
Myocardial infarction , deferred stenting , No-reflow , myocardial salvage , Primary percutaneous coronary intervention
