A randomized trial of deferred stenting versus immediate stenting to prevent No- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI)

David Carrick, Keith G. Oldroyd, Margaret McEntegart, Caroline Haig, Mark C. Petrie, Hany Eteiba, Stuart Hood, Colum Owens, Stuart Watkins, Jamie Layland, Mitchell Lindsay, Eileen Peat, Alan Rae, Miles Behan, Arvind Sood, W. Stewart Hillis, Ify Mordi, Ahmed Mahrous, Nadeem Ahmed, Rebekah WilsonLaura Lasalle, Philippe Généreux, Ian Ford, Colin Berry

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Abstract

Objectives The aim of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Background No-reflow is associated with adverse outcomes in STEMI. Methods This was a prospective, single-center, randomized, controlled, proof-of-concept trial in reperfused STEMI patients with >1 risk factors for no-reflow. Randomization was to deferred stenting with an intention-to-stent 4 to 16 h later or conventional treatment with immediate stenting. The primary outcome was the incidence of no-/slow-reflow (Thrombolysis In Myocardial Infarction ≤2). Cardiac magnetic resonance imaging was performed 2 days and 6 months after myocardial infarction. Myocardial salvage was the final infarct size indexed to the initial area at risk. Results Of 411 STEMI patients (March 11, 2012 to November 21, 2012), 101 patients (mean age, 60 years; 69% male) were randomized (52 to the deferred stenting group, 49 to the immediate stenting). The median (interquartile range [IQR]) time to the second procedure in the deferred stenting group was 9 h (IQR: 6 to 12 h). Fewer patients in the deferred stenting group had no-/slow-reflow (14 [29%] vs. 3 [6%]; p = 0.006), no reflow (7 [14%] vs. 1 [2%]; p = 0.052) and intraprocedural thrombotic events (16 [33%] vs. 5 [10%]; p = 0.010). Thrombolysis In Myocardial Infarction coronary flow grades at the end of PCI were higher in the deferred stenting group (p = 0.018). Recurrent STEMI occurred in 2 patients in the deferred stenting group before the second procedure. Myocardial salvage index at 6 months was greater in the deferred stenting group (68 [IQR: 54% to 82%] vs. 56 [IQR: 31% to 72%]; p = 0.031]. Conclusions In high-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573)

Original languageEnglish
Pages (from-to)2088-2098
Number of pages11
JournalJournal of the American College of Cardiology
Volume63
Issue number20
DOIs
Publication statusPublished - 27 May 2014

Keywords

  • deferred stenting
  • myocardial infarction
  • myocardial salvage
  • no-reflow
  • primary percutaneous coronary intervention

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    Carrick, D., Oldroyd, K. G., McEntegart, M., Haig, C., Petrie, M. C., Eteiba, H., Hood, S., Owens, C., Watkins, S., Layland, J., Lindsay, M., Peat, E., Rae, A., Behan, M., Sood, A., Hillis, W. S., Mordi, I., Mahrous, A., Ahmed, N., ... Berry, C. (2014). A randomized trial of deferred stenting versus immediate stenting to prevent No- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI). Journal of the American College of Cardiology, 63(20), 2088-2098. https://doi.org/10.1016/j.jacc.2014.02.530