Acute Coronary Syndromes (STEMI, NSTE-ACS)
Immediate Versus Deferred Stenting for ST Elevation Myocardial Infarct With High Burden Thrombus: A Meta-Analysis From Different Perspective
Hendy Bhaskara Perdana Putra1, Noer Halimatus Syakdiyah2, Yusra Pintaningrum3, Maria Adventia Debi Mustika Martin1
Dr. Ramelan Navy Hospital Surabaya, Indonesia1, Airlangga University, Indonesia2, Mataram University, Indonesia3
Immediate coronary stenting remains a cornerstone in the last guideline of management ST segment elevation myocardial infarction (STEMI). In the other hand, deferred stenting had shown no significant clinical benefit in several RCT in general population. Several studies have compared deferred stenting to immediate stenting in special population with high burden thrombus. However, the result remains inconclusive.
We performed a systematic literature search from several electronic databases. We used keyword “deferred stenting” or “delayed stenting” and “high burden thrombus”. The inclusion criteria were studies comparing immediate stenting and deferred stenting in STEMI patients who underwent primary PCI, either randomized or non – randomized was accepted. The primary endpoints were distal embolization and no/slow - reflow. Secondary endpoints were TIMI 3 flow, myocardial blush grade (MBG) 3, in - hospital mortality and in – hospital bleeding. Odds ratio (OR) with 95% confidence intervals (CIs) were used to report all outcomes.
A total of ten studies were selected with 1.281 patients were pooled in our analysis. 462 patients in deferred stenting group and 819 patients in immediate stenting group.Compared to immediate stenting, deferred stenting in STEMI patients with high burden thrombus significantly reduce distal embolization (OR=0.29 [95% CI, 0.16-0.53], p<0.0001) and no/slow reflow phenomenon (OR=0.42 [95% CI, 0.26-0.68], p=0.0004). At the other side, deferred stenting significantly increases TIMI 3 flow (OR=2.37 [95% CI, 1.58-3.55], p<0.0001) and MBG 3 (OR=3.68 [95% CI, 1.81-7.46], p=0.0003). However, there were insignificant increase of in - hospital mortality (OR=2.37 [95% CI, 0.85-6.58], p=0.10) and in – hospital bleeding (OR=1.92 [95% CI, 0.81-4.52], p=0.14).
Deferred stenting in STEMI patients with high burden thrombus, not only significantly reduce distal embolization and no/slow reflow phenomenon, but also significantly increases TIMI 3 flow and MBG 3.