Deferred Versus Immediate Stenting in Patients With ST‐Segment Elevation Myocardial Infarction: A Systematic Review and Meta‐Analysis

Abstract

BackgroundA 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 ResultsWe 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, I2=70%) but not in observational studies (OR 0.13, 95%CI 0.06‐0.31, P<0.0001, I2=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, I2=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, I2=0%; nonrandomized OR 0.30, 95%CI 0.15‐0.58, P=0.0004, I2=0%]), major bleeding (OR=0.1.61, 95%CI 0.70‐3.69, P=0.26, I2=0%), death (OR=0.78, 95%CI 0.53‐1.15, P=0.22, I2=0%), MI (OR=0.97, 95%CI 0.34‐2.78, P=0.96, I2=35%) and target vessel revascularization (OR 0.97, 95%CI 0.40‐2.37, P=0.95, I2=24%), between deferred and immediate stenting.ConclusionsCompared 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.

Deferred Stenting in a HIV Infected Patient with STEMI and Heparin Induced Thrombocytopenia

“…A meta-analysis of 9 studies where majority of the patients taken from randomized clinical trial (RCT) (1456 patients) and only 719 patients were taken from observational studies showed a long term benefit of deferred stenting in terms of improvement in left ventricular EF [9]. DANAMI 3 -DEFER study showed not much benefits with deferred stenting when compared to routine stenting [10]. Cardiac magnetic resonance sub-study of DANAMI 3 -DEFER showed routine deferred stenting have no role in salvaging the myocardium and in the reduction of microvascular obstruction or size of the infarct [11].…”

Management of Intracoronary Thrombus

“…Furthermore, despite appropriate administration of antiplatelet agents, patients are often taken to the catheterization laboratory before these agents have achieved their desired therapeutic effect. One strategy to overcome this issue is 'deferred stenting', a practice that is not recommended routinely for all STEMI patients [46]. In selected cases, with high thrombus burden that are haemodynamically stable, deferred stenting may offer a therapeutic option.…”

Реканалізація Коронарних Артерій У Пацієнтів Із Гострим Інфарктом Міокарда

“…Одним з ефективних шляхів зменшення відсотка фатальних результатів ІХС є ендоваскулярна реканалізація інфаркт-пов'язаної артерії (ІПА) [4]. Дійсно, первинне черезшкірне коронарне втручання з імплантацією стентів нині є стандартною терапією для пацієнтів із гострим інфарктом міокарда (ГІМ) з підйомом сегмента ST (STEMI) [5].…”

“…Останні наукові дослідження зосереджені на скороченні негативних перипроцедуральних клінічних подій, включаючи ішемію, кровотечі і летальність [6]. Однак, згідно з даними Qiao J. і співавт., в сучасних дослідженнях відзначається неузгодженість підходів не тільки до стратегії, а й до тимчасової тактики проведення стентування [4].…”