Effect of Delayed vs Immediate Stent Implantation on Myocardial Perfusion and Cardiac Function in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention With Thrombus Aspiration

Tang, Liang; Zhou, Shenghua; Hu, Xinqun; Fang, Zhenfei; Shen, Xiongjie

doi:10.1016/j.cjca.2011.03.001

Cited by 40 publications

(37 citation statements)

References 28 publications

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“…Therefore, a strategy of delayed stent implantation (DSI) after thrombus removal, compared to immediate stent implantation (ISI), appears attractive. To date, only few and small studies have been published comparing these two strategies [89][90][91] , but they all showed that DSI is associated with better microvascular perfusion, less frequent distal embolization and no-reflow, compared with ISI. Certainly, in STEMI setting with LTB, DSI has to be weighed against the potential risk of recurrent ischemia and bleeding episodes during the waiting period before PCI.…”

Section: Embolic Protection Devicesmentioning

confidence: 99%

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

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Acute ST-elevation myocardial infarction (STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator, which is mostly proportional to their size and composition. Particularly, intracoronary thrombi impair both epicardial blood flow and myocardial perfusion, by occluding major coronary arteries and causing distal embolization, respectively. Thus, although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting, the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients, by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used in the setting of STEMI to manage thrombotic lesions.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: ST-elevation myocardial infarction; Intracoronary thrombosis; Primary percutaneous coronary intervention; Antithrombotic therapies; Coronary thrombectomyCore tip: Intracoronary thrombosis, is the basic pathophysiologic event in acute ST-elevation myocardial infarction (STEMI), and thrombi are very frequently detected in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Thrombus burden and components are important determinants of prognosis in STEMI, being well-known risk factors for longterm adverse cardiovascular events, distal embolization and stent thrombosis. As a result, percutaneous management of lesions with a consistent thrombotic burden is still challenging in the setting of PPCI for STEMI. Therefore, several pharmacological and interventional strategies, such as thrombectomy have been developed in order to improve PPCI's safety and efficacy, by reducing thrombus burden.

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Section: Embolic Protection Devicesmentioning

confidence: 99%

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Vecchio¹

2014

WJC

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“…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.…”

mentioning

confidence: 99%

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

Belle

Motreff

Mangin

et al. 2016

Circ: Cardiovascular Interventions

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Background-Delayed stent implantation after restoration of normal epicardial flow by a minimalist immediate mechanical intervention aims to decrease the rate of distal embolization and impaired myocardial reperfusion after percutaneous coronary intervention. We sought to confirm whether a delayed stenting (DS) approach (24-48 hours) improves myocardial reperfusion, versus immediate stenting, in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Methods and Results-In the prospective, randomized, open-label minimalist immediate mechanical intervention (MIMI)trial, patients (n=140) with ST-segment-elevation myocardial infarction ≤12 hours were randomized to immediate stenting (n=73) or DS (n=67) after Thrombolysis In Myocardial Infarction 3 flow restoration by thrombus aspiration. Patients in the DS group underwent a second coronary arteriography for stent implantation a median of 36 hours (interquartile range 29-46) after randomization. The primary end point was microvascular obstruction (% left ventricular mass) on cardiac magnetic resonance imaging performed 5 days (interquartile range 4-6) after the first procedure. There was a nonsignificant trend toward lower microvascular obstruction in the immediate stenting group compared with DS group (1.88% versus 3.96%; P=0.051), which became significant after adjustment for the area at risk (P=0.049). Median infarct weight, left ventricular ejection fraction, and infarct size did not differ between groups. No difference in 6-month outcomes was apparent for the rate of major cardiovascular and cerebral events. Conclusions-The

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“…Двухэтапная методика отсроченного стентирования от 24 ч и до 5 сут. у пациентов с исходным коронарным кровотоком TIMI 3 с целью минимизации развития дистальной эмболизации и микровасулярной обструкции демонстрируют достаточно хорошие показатели [13]. В исследовании DEFER-STEMI (Randomised Controlled Study to Assess Whether Deferred Stenting in Acute STEMI Patients Might Reduce the Incidence of No-reflow Versus Conventional Treatment With Immediate Stenting -коротко Deferred Stent Trial in STEMI) отсроченное вмешательство (в среднем через 9 ч -4-16 ч) позволило значимо уменьшить число пациентов с феноменом no/slow-reflow, получить более высокую градацию кровотока по TIMI [14].…”

Section: Discussionunclassified

The Results of Delayed Endovascular Intervention in St Elevation Acute Myocardial Infarction Due to Thrombotic Occlusion of Coronary Artery

Azarov¹,

Семитко²,

Glezer³

et al. 2017

Kardiovask. ter. profil.

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1ГБУЗ МО "Мытищинская городская клиническая больница". Московская область; 2 ФГБОУ ВО "Российский национальный исследовательский медицинский университет им. Н. И. Пирогова" Минздрава России. Москва; 3 ФГБОУ ВО "Первый Московский государственный медицинский университет им. И. М. Сеченова" Минздрава России. Москва, Россия Цель. Изучить клинические результаты и безопасность отсроченного vs экстренного стентирования с использованием современных антитромботических препаратов при массивном коронарном тромбозе у больных острым инфарктом миокарда с подъемом сегмента ST (ИМ↑ST). Материал и методы. В исследование вошли 28 пациентов с острым ИМ↑ST в возрасте 52 (25-77) лет, из них мужского пола 80% (n=23), которые в период с января 2014г по февраль 2016г в первые 6-12 ч от начала развития заболевания получили эндоваскулярное лечение с целью восстановления адекватного кровотока без экстренной имплантации стента в инфаркт-ответственную артерию. Минимальная инвазивная стратегия с целью восстановления антеградного кровотока до уровня TIMI 2-3 была выполнена 14 (50%) больным. У всех больных после восстановления антеградного кровотока в просвете артерии визуализировался тромбоз по шкале TIMI thrombus grade score (TTG) ≥3. Следующим критерием эффективности являлась резолюция сегмента ST на ЭКГ ≥50%. В качестве антитромботической поддержки при вмешательстве все пациенты получали сочетание блокаторов IIb/IIIa гликопротеиновых рецепторов (эптифибатид) и 600 мг клопидогрела или 180 мг тикагрелора. Повторная коронароангиография (КАГ) выполнялась в сроки до 5 сут. Результаты. На 4,0±1,0 сутки кровоток TIMI 2-3 в инфаркт-ответственной артерии был сохранен у 100% пациентов; отмечено значимое уменьшение степени целевого стеноза в инфаркт-связанной артерии с 77,8±10,2% до 50,5±19,5%; уменьшение его протяженности с 21,5±8,5 до 15,5±5,5 мм; увеличение референсного диаметра целевой артерии от 3,1±0,8 до 3,5±0,75 мм и степени тромбоза по шкале TTG -от 3,9 до 0,9. По результатам повторной КАГ стентирование целевого сегмента выполнено у 8 (29%) пациентов, а у 3 (10%) больных стентирование выполнено на основании данных внутрисосудистого ультразвукового исследования. У 17 (61%) пациентов инфаркт-ответственное стенотическое поражение признано незначимым. В группе отсроченного стентирования не было отмечено ни одного случая развития феноменов no/slow-reflow. На госпитальном этапе лечения в группе наблюдения кардиальных событий не зарегистрировано. Заключение. У больных c массивным тромбозом инфаркт-зависимой артерии (TTG ≥3) и восстановленным антеградным коронарным кровотоком TIMI 2-3 отсроченное стентирование является безопасной и эффективной стратегией лечения на госпитальном этапе. Ключевые слова: острый инфаркт миокарда с подъемом сегмента ST, чрескожное коронарное вмешательство, коронарное стентирование.Кардиоваскулярная терапия и профилактика, 2017; 16(1): 40-45 http://dx.

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Effect of Delayed vs Immediate Stent Implantation on Myocardial Perfusion and Cardiac Function in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention With Thrombus Aspiration

Cited by 40 publications

References 28 publications

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management

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

The Results of Delayed Endovascular Intervention in St Elevation Acute Myocardial Infarction Due to Thrombotic Occlusion of Coronary Artery

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