Magdy Ahmed M, Demitry Salwa R, Hasan-Ali Hosam, Zaky Mohamed, Abd El-Hady Mohamed, Abdel Ghany Mohamed
Cardiovascular Medicine, National Heart Institute, Cairo, Egypt.
Cardiovascular Medicine, Faculty of Medicine, Assiut University, Asyut, Egypt.
Egypt Heart J. 2021 Sep 9;73(1):78. doi: 10.1186/s43044-021-00203-3.
Deferred stenting, despite being successful in early studies, showed no benefit in recent trials. However, these trials were testing routine deferral; not in patients with heavy thrombus burden.
This is a prospective, Randomized Clinical Trial that included 150 patients who presented with STEMI, patients were allocated into three equal groups after the coronary angiography ± primary intervention and before stenting of the culprit lesion; group (A) included 50 patients with early deferral of stenting, group (B) included 50 patients with late deferral and group (C) included 50 patients with immediate stenting. No-reflow was significantly higher in group C, while Final TIMI flow grade 3 and MBG grade 3 were significantly higher in group A and B than group C; p = 0.019 and < 0.001 respectively, with no significant difference between groups A and B, only the thrombus resolution in group B was significantly higher than group A; p < 0.001. Finally, 6-months, over-all MACE was significantly higher in group C (34.7% vs. 14.6% and 16.3%, p = 0.029).
Stent deferral was proved to be better than immediate stenting after recanalization of IRA, in achieving TIMI III flow, reducing risk of 6 months MACE, and restoration of myocardial function in a subset of STEMI patients presenting with large thrombus burden. While, no significant difference was found between both deferral times in final TIMI flow, or clinical outcomes.
延迟支架置入术尽管在早期研究中取得了成功，但在近期试验中未显示出益处。然而，这些试验测试的是常规延迟；而非针对血栓负荷重的患者。
这是一项前瞻性随机临床试验，纳入了150例ST段抬高型心肌梗死（STEMI）患者，在冠状动脉造影±初次干预后且在罪犯病变置入支架前，将患者分为三组，每组50例；A组包括50例早期延迟支架置入患者，B组包括50例晚期延迟患者，C组包括50例即刻支架置入患者。C组无复流发生率显著更高，而A组和B组的最终心肌梗死溶栓试验（TIMI）血流3级和心肌梗死溶栓试验心肌灌注分级（MBG）3级显著高于C组；p分别为0.019和<0.001，A组和B组之间无显著差异，仅B组的血栓溶解率显著高于A组；p<0.001。最后，C组6个月时总体主要不良心血管事件（MACE）显著更高（34.7% 对14.6%和16.3%，p = 0.029）。
对于IRA再通后血栓负荷大的部分STEMI患者，支架延迟置入在实现TIMI Ⅲ级血流、降低6个月MACE风险及恢复心肌功能方面被证明优于即刻支架置入。而在最终TIMI血流或临床结局方面，两种延迟时间之间未发现显著差异。
