Hesham Hammad Ahmed, Abdelaziz Ismaiel Mahmoud, H Abd-Elnaby Mohammed, Khaleel Taha Attaa, Kabil Hamza
Cardiology, Faculty of Medicine, Mansoura University, Mansoura, EGY.
Cardiology, Global Medical City Hospital, Cairo, EGY.
Cureus. 2025 Jun 18;17(6):e86317. doi: 10.7759/cureus.86317. eCollection 2025 Jun.
Late-presenting patients with ST-segment elevation myocardial infarction (STEMI), defined as those presenting ≥12 hours after symptom onset, represent a high-risk and often underrepresented population. Despite evidence supporting primary percutaneous coronary intervention (PCI) in these patients, those with a high thrombus burden (HTB) face an increased risk of no reflow and adverse outcomes, particularly with immediate stenting. The optimal stent timing in this subgroup remains unclear.
This retrospective study included 200 patients with late-presenting STEMI and angiographically confirmed HTB. Patients were assigned to either the deferred stenting (DS; n=100) group or the immediate stenting (IS; n=100) group. Clinical and procedural outcomes, including myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) flow, and major adverse cardiovascular events (MACE) at one year, were compared.
The DS group was associated with significantly lower no reflow (11 (11%) vs. 26 (26%), p=0.01), less distal embolization (6 (6%) vs. 16 (16%), p=0.04), and higher post-PCI TIMI grade 3 flow (73 (73%) vs. 57 (57%), p=0.03) and MBG 3 (58 (58%) vs. 36 (36%), p=0.01). One-year MACE was significantly reduced in the DS group (7 (7%) vs. 20 (20%), p=0.01). The DS group was independently associated with improved myocardial perfusion and lower MACE.
In late-presenting STEMI patients with HTB, deferred stenting yielded superior perfusion and clinical outcomes compared to immediate stenting. These findings underscore the importance of individualized stent timing strategies in this high-risk, often overlooked subgroup.
症状出现≥12小时后就诊的ST段抬高型心肌梗死（STEMI）患者属于高危人群，且在相关研究中常未得到充分体现。尽管有证据支持对这类患者进行直接经皮冠状动脉介入治疗（PCI），但血栓负荷高（HTB）的患者发生无复流和不良结局的风险增加，尤其是在立即置入支架时。该亚组患者的最佳支架置入时机仍不明确。
这项回顾性研究纳入了200例症状出现较晚且经血管造影证实有HTB的STEMI患者。患者被分为延迟支架置入（DS；n = 100）组或立即支架置入（IS；n = 100）组。比较了临床和手术结局，包括心肌 blush分级（MBG）、心肌梗死溶栓（TIMI）血流以及1年时的主要不良心血管事件（MACE）。
DS组的无复流发生率显著更低（11例（11%）对26例（26%），p = 0.01），远端栓塞更少（6例（6%）对16例（16%），p = 0.04），PCI术后TIMI 3级血流更高（73例（73%）对57例（57%），p = 0.03），MBG 3级更高（58例（58%）对36例（36%），p = 0.01）。DS组1年时的MACE显著减少（7例（7%）对20例（20%），p = 0.01）。DS组与心肌灌注改善和MACE降低独立相关。
在症状出现较晚且有HTB的STEMI患者中，与立即支架置入相比，延迟支架置入产生了更好的灌注和临床结局。这些发现强调了在这个高危且常被忽视的亚组中个体化支架置入时机策略的重要性。
