Annecy-Genevois Hospital, Annecy, France.
EuroIntervention. 2017 Jul 20;13(4):390-396. doi: 10.4244/EIJ-D-16-00667.
The aim of this study was to ascertain whether a minimalist immediate mechanical intervention (MIMI) aiming to restore an optimal Thrombolysis In Myocardial Infarction (TIMI) flow in the culprit artery, followed ≥7 days later by a second percutaneous coronary intervention with intentional stenting, is safe in patients with ST-segment elevation myocardial infarction and large thrombotic burden.
SUPER-MIMI was a prospective, observational trial conducted between January 2014 and April 2015 in 14 French centres. A total of 155 patients were enrolled. The pharmacological therapy was left to the operator's discretion. Eighty-one patients (52.3%) had glycoprotein IIb/IIIa inhibitors (GPI) initiated before the end of the first procedure. The median (interquartile range [IQR]) delay between the two procedures was eight (seven to 12) days. Infarct-related artery reocclusion between the two procedures (primary endpoint) occurred in two patients (1.3%), neither of whom received GPI treatment. TIMI flow was maintained or improved between the end of the first procedure and the beginning of the second procedure in all patients. Thrombotic burden and stenosis severity diminished significantly between the two procedures. Stents were ultimately implanted in 97 patients (62.6%).
Deferred stenting (≥7 days) in patients with a high thrombus burden was safe on a background of GPI therapy.
本研究旨在确定在罪犯动脉中恢复最佳的溶栓治疗（TIMI）血流的最小化即刻机械干预（MIMI）是否安全，即在罪犯动脉中恢复最佳的溶栓治疗（TIMI）血流，随后在≥7 天后进行第二次经皮冠状动脉介入治疗并进行有意的支架置入术，适用于 ST 段抬高型心肌梗死且血栓负荷较大的患者。
SUPER-MIMI 是一项前瞻性、观察性试验，于 2014 年 1 月至 2015 年 4 月在 14 个法国中心进行。共纳入 155 例患者。药物治疗由术者自行决定。81 例患者（52.3%）在第一程序结束前开始使用糖蛋白 IIb/IIIa 抑制剂（GPI）。两次操作之间的中位数（四分位距[IQR]）延迟为 8（7 至 12）天。在两次操作之间发生梗死相关动脉再闭塞（主要终点）的患者有 2 例（1.3%），均未接受 GPI 治疗。所有患者在第一次操作结束和第二次操作开始之间，TIMI 血流保持或改善。两次操作之间血栓负荷和狭窄程度显著降低。最终有 97 例患者（62.6%）植入支架。
在 GPI 治疗的背景下，对血栓负荷较高的患者进行延迟支架置入术（≥7 天）是安全的。
