Delayed versus immediate stenting for the treatment of ST-elevation acute myocardial infarction with a high thrombus burden

Abstract

For STEMI patients with HTB who have undergone initial thrombectomy, delayed stenting is safe and feasible, and may be associated with better immediate myocardial perfusion, more LV function recovery, and less occurrence of MACE at the 1-year follow-up.

Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction

“…2,3 Numerous mechanisms may explain the development of MVO in STEMI, including PCI-induced distal embolization of thrombus and friable atheromatous plaques. 2,4 In an attempt to decrease the rate of distal embolization and impaired myocardial reperfusion, the concept of delayed stent implantation after restoration of normal epicardial flow by a minimalist immediate mechanical intervention (MIMI) was initiated by Isaaz et al 5 Limited data from retrospective, observational, and matched-comparison studies have suggested that delayed stenting (DS) is associated with higher rates of procedural success compared with immediate stenting (IS), 6 higher 6-month left ventricular (LV) ejection fraction, 7,8 and lower rates of adverse events. 7,9,10 A singlecenter proof-of-concept study reported a lower rate of angiographic no-reflow in patients treated with DS versus IS, but the population was limited to individuals with a high risk of no-reflow.…”

“…2,4 In an attempt to decrease the rate of distal embolization and impaired myocardial reperfusion, the concept of delayed stent implantation after restoration of normal epicardial flow by a minimalist immediate mechanical intervention (MIMI) was initiated by Isaaz et al 5 Limited data from retrospective, observational, and matched-comparison studies have suggested that delayed stenting (DS) is associated with higher rates of procedural success compared with immediate stenting (IS), 6 higher 6-month left ventricular (LV) ejection fraction, 7,8 and lower rates of adverse events. 7,9,10 A singlecenter proof-of-concept study reported a lower rate of angiographic no-reflow in patients treated with DS versus IS, but the population was limited to individuals with a high risk of no-reflow. 11 The MIMI trial was conducted to confirm whether delayed (24-48 hours) versus immediate stent implantation significantly reduced myocardial MVO as determined by cardiac magnetic resonance imaging (MRI), thus improving myocardial reperfusion in patients with acute STEMI undergoing primary PCI.…”

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

“…The benefit was most likely due to the beneficial effect of deferred stenting on myocardial perfusion. 10 Bethke and colleagues found that the TIMI myocardial perfusion grade at the end of the PCI procedure was significantly associated with LVEF and infarct size after 3 months in STEMI patients. 27 Our comparative findings were not consistent with a previous meta-analysis, 28 which showed improved angiographic outcomes in deferred-stenting patients.…”

“…6,7 The concept of deferred stent implantation after restoration of normal epicardial flow by a minimalist immediate mechanical intervention (MIMI) for STEMI management was proposed for the first time by Isaaz et al 8 Several subsequent observational studies have suggested that deferred stenting was associated with higher rates of procedural success, higher 6-month left ventricular ejection fraction (LVEF), and lower rates of adverse events compared with immediate stenting. [9][10][11] Recently, findings from new randomized controlled trials (RCTs) were available, showing some inconsistent results with previous observational studies. 12,13 To provide a clearer understanding of this important issue, we performed a meta-analysis of deferred vs immediate stenting in patients with acute STEMI.…”

Cardiovascular Diagnosis and Therapy (CDT) Editorial: the Minimalist Immediate Mechanical Intervention study

“…However, since stent implantation may cause intraprocedural thrombotic complications (IPTEs), including distal embolization of thrombus leading to microvascular obstruction (MVO) and no-reflow (2,3) some clinicians have questioned whether immediate stent implantation is mandated in all patients, or instead, whether stent implantation could be deferred for a limited period to enable the beneficial effects of restored blood flow and medical therapy. With this in mind, a number of clinical investigations of deferred stenting (DS) strategies have been assessed (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). This was the focus of the Minimalist Immediate Mechanical Intervention (MIMI) trial (14).…”