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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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
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Petrie, Professor Mark and Eteiba, Dr Hany and Layland, Dr Jamie and Haig, Dr Caroline and Ford, Professor Ian and Mordi, Dr Ify and Hood, Dr Stuart
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 > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Scottish Medical Journal
Publisher:SAGE Publications
ISSN (Online):2045-6441

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