A randomised controlled trial of deferred stenting versus immediate stenting to prevent no-reflow in acute ST-elevation myocardial infarction

Carrick, D. et al. (2013) A randomised controlled trial of deferred stenting versus immediate stenting to prevent no-reflow in acute ST-elevation myocardial infarction. Scottish Medical Journal, 58(3), e41-e41. (doi: 10.1177/0036933013495794)

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Abstract

Background: In primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI), no-reflow after stenting may cause heart failure acutely and in the longer term. Currently there are no evidence-based treatments for no-reflow. We hypothesised that after initial reperfusion, deferral of stent implantation, might reduce no-reflow and its sequelae compared to usual care with immediate stenting. Methods: A prospective single centre randomised controlled trial in consecutive STEMI patients. Patients with risk factors for no-reflow were eligible if TIMI 3 flow had been established by initial aspiration thrombectomy and/or balloon angioplasty. Randomisation was to deferred stenting (DS, 4–16 h later) or usual care with immediate stenting (IS). The primary end-point was the incidence of no-reflow (TIMI 0/1 flow). MRI was performed two days post-MI and all patients had prospective follow-up. Results: Of 451 consecutive STEMI patients treated in our centre (11 March–21 November 2012), 101 patients were randomised (n=52 DS, n=49 IS). Compared with usual care, no-reflow was less frequent in the DS group: 0.0% vs. 10% (p=0.005), as were intra-procedural thrombotic events (IPTEs), 14% vs. 41% (p=0.003), and microvascular obstruction was revealed by MRI, 44% vs. 59% (p=0.36). Conclusion: For the first time we have found that a strategy of deferred stenting in selected patients reduced no reflow and IPTEs in primary PCI. Our intervention is pragmatic and potentially widely applicable. Our results support the rationale for a multicentre trial to assess the safety and cost-effectiveness of deferred stenting in primary PCI.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hood, Dr Stuart and Eteiba, Dr Hany and Petrie, Professor Mark and Layland, Dr Jamie and Ford, Professor Ian and Berry, Professor Colin and Haig, Dr Caroline and Mordi, Dr Ify
Authors: Carrick, D., McEntegart, M., Haig, C., Petrie, M.C., Eteiba, H., Hood, S., Owens, C., Watkins, S., Layland, J., Behan, M., Sood, A., Hillis, W.S., Mordi, I., Ahmed, N., Genereux, P., Ford, I., and Berry, C.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:Scottish Medical Journal
Publisher:SAGE Publications
ISSN:0036-9330
ISSN (Online):2045-6441

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