A randomized trial of deferred stenting versus immediate stenting to prevent no- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI)
| Autor: | Arvind Sood, Stuart Watkins, Eileen Peat, Ahmed Mahrous, Alan P. Rae, Hany Eteiba, Jamie Layland, David Carrick, Laura LaSalle, Mitchell Lindsay, Keith G. Oldroyd, Colin Berry, Colum Owens, Miles Behan, Nadeem Ahmed, Stuart Hood, Philippe Généreux, Rebekah Wilson, Margaret McEntegart, Ify Mordi, Caroline Haig, Mark C. Petrie, W. Stewart Hillis, Ian Ford |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Myocardial Infarction Coronary Angiography Ventricular Function Left Electrocardiography Percutaneous Coronary Intervention Interquartile range Internal medicine Coronary Circulation Medicine Humans cardiovascular diseases Myocardial infarction Prospective Studies business.industry Stent Percutaneous coronary intervention Thrombolysis Middle Aged primary percutaneous coronary intervention equipment and supplies medicine.disease Surgery myocardial salvage surgical procedures operative Treatment Outcome Conventional PCI No reflow phenomenon cardiovascular system Cardiology deferred stenting No-Reflow Phenomenon no-reflow Female Stents business Cardiology and Cardiovascular Medicine TIMI Follow-Up Studies |
| Zdroj: | Journal of the American College of Cardiology. 63(20) |
| ISSN: | 1558-3597 |
| Popis: | Objectives The aim 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). Background No-reflow is associated with adverse outcomes in STEMI. Methods This was 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. Results Of 411 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]. Conclusions In high-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573 ) |
| Databáze: | OpenAIRE |
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