Pradhan Akshyaya, Bhandari Monika, Vishwakarma Pravesh, Sethi Rishi
Department of Cardiology, King George's Medical University Lucknow, India.
Eur Cardiol. 2021 Mar 30;16:e08. doi: 10.15420/ecr.2020.31. eCollection 2021 Feb.
Patients with ST-elevation MI (STEMI) usually have a huge thrombus burden in the infarct-related artery. Stenting may lead to high chances of the slow-flow/no-reflow phenomenon that leads to periprocedural MI and adverse cardiovascular events. Deferred stenting may be beneficial in this situation as the thrombus burden will reduce, mitigating the slow-flow/no-reflow phenomenon. However, routine deferral of stenting in patients with STEMI has not been found to be beneficial, but when the patient is properly selected, deferred stenting has the potential for reducing the final infarct size. The authors report the safety and feasibility of deferred stenting after 5 days of prolonged anticoagulation in a 45-year-old smoker with STEMI who had a large thrombus load shown on an angiogram. They review the registries, trials and meta-analyses on deferred stenting in the literature and analyse the benefits and harms of the strategy. They also propose an algorithm for applying a strategy for deferred stenting in clinical practice based on the available data.
ST段抬高型心肌梗死（STEMI）患者梗死相关动脉通常有巨大血栓负荷。支架置入可能导致慢血流/无复流现象的高发生率，进而导致围手术期心肌梗死和不良心血管事件。在这种情况下，延迟支架置入可能有益，因为血栓负荷会减轻，从而减轻慢血流/无复流现象。然而，尚未发现对STEMI患者常规延迟支架置入有益，但在正确选择患者时，延迟支架置入有可能减小最终梗死面积。作者报告了一名45岁STEMI吸烟患者在延长抗凝5天后延迟支架置入的安全性和可行性，该患者血管造影显示有巨大血栓负荷。他们回顾了文献中关于延迟支架置入的注册研究、试验和荟萃分析，并分析了该策略的利弊。他们还根据现有数据提出了一种在临床实践中应用延迟支架置入策略的算法。
