Pradhan Akshyaya, Uppal Shivam, Vishwakarma Pravesh, Singh Abhishek, Bhandari Monika, Shukla Ayush, Sharma Akhil, Chaudhary Gaurav, Chandra Sharad, Sethi Rishi, Dwivedi Sudhanshu Kumar
Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.
Department of Cardiology, Pushpanjali Hospital, Rewari 123401, Haryāna, India.
World J Cardiol. 2025 Feb 26;17(2):99074. doi: 10.4330/wjc.v17.i2.99074.
Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-segment elevation myocardial infarction (STEMI). However, in patients with high thrombus burden, immediate stenting during PCI can lead to poor outcomes due to the risk of thrombus migration and subsequent microvascular occlusion, resulting in no-reflow phenomena. Deferred stenting offers a potential advantage by allowing for the reduction of thrombus load, which may help to minimize the incidence of slow-flow and no-reflow complications. This study explores the effectiveness of a deferred stenting strategy in improving outcomes for STEMI patients.
To evaluate the effectiveness and safety of deferred PCI in a real-world setting in acute STEMI patients.
This study was conducted at King George's Medical University, Lucknow, from October 1, 2018, to October 30, 2019 and included a total of 55 participants. Patients with acute STEMI who underwent coronary angiography were selected for a deferred PCI strategy based on specific angiographic features.
Anterior wall myocardial infarction was the predominant type of STEMI in 62% of the selected 55 patients (mean age: 54 years; 70% males), and diabetes mellitus was the most common risk factor (18.2%), followed by hypertension (16.2%). On the second angiogram of these patients measures of thrombus grade, thrombolysis in myocardial infarction flow grade, myocardial blush grade, and severity of stenosis of culprit lesion were considerably improved compared to the first angiogram, and the average culprit artery diameter had increased by 7.8%. Most patients (60%) had an uneventful hospital stay during the second angiogram and an uneventful intraprocedural course (85.19%), with slow-flow/no-reflow occurring only in 7.4% of the patients; these patients recovered after taking vasodilator drugs. In 29.3% of patients, the culprit artery was recanalized, preventing unnecessary stent deployment.
Deferred PCI strategy is safe and reduces the thrombus burden, improves thrombolysis in myocardial infarction (TIMI) flow, improves myocardial blush grade, and prevents unwarranted stent deployment.
直接经皮冠状动脉介入治疗（PCI）是ST段抬高型心肌梗死（STEMI）的首选治疗方法。然而，在血栓负荷较高的患者中，PCI期间立即置入支架可能因血栓迁移和随后的微血管阻塞风险而导致不良预后，从而引发无复流现象。延迟置入支架通过减少血栓负荷具有潜在优势，这可能有助于将慢血流和无复流并发症的发生率降至最低。本研究探讨延迟置入支架策略对改善STEMI患者预后的有效性。
评估在急性STEMI患者的实际临床环境中延迟PCI的有效性和安全性。
本研究于2018年10月1日至2019年10月30日在勒克瑙的乔治国王医学院进行，共纳入55名参与者。根据特定的血管造影特征，对接受冠状动脉造影的急性STEMI患者采用延迟PCI策略。
在入选的55例患者中，62%的患者主要为前壁心肌梗死（平均年龄：54岁；70%为男性），糖尿病是最常见的危险因素（18.2%），其次是高血压（16.2%）。与首次血管造影相比，这些患者第二次血管造影时的血栓分级、心肌梗死溶栓血流分级、心肌灌注分级和罪犯病变狭窄严重程度均有显著改善，罪犯动脉平均直径增加了7.8%。大多数患者（60%）在第二次血管造影期间住院过程顺利，手术过程顺利（85.19%），只有7.4%的患者出现慢血流/无复流；这些患者在使用血管扩张药物后康复。29.3%的患者罪犯动脉再通，避免了不必要的支架置入。
延迟PCI策略安全，可减轻血栓负荷，改善心肌梗死溶栓（TIMI）血流，改善心肌灌注分级，并避免不必要的支架置入。
