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Deferred stenting safe but not beneficial in patients with STEMI
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Delaying stenting by 3 to 7 days in patients with STEMI who are undergoing primary PCI did not reduce infarct size or microvascular obstruction compared with immediate stenting, according to results from the INNOVATION study.
Je Sang Kim, MD, from the division of cardiology, department of internal medicine, Sejong General Hospital in Bucheon, Korea, and colleagues randomly assigned 114 patients (mean age, 69 years) with STEMI requiring primary PCI to delayed stenting with intention to stent in 3 to 7 days or immediate stenting after primary reperfusion.
The primary endpoint was infarct size. The secondary endpoint was incidence of microvascular obstruction as confirmed by cardiac MRI 30 days after primary reperfusion.
In the delayed-stenting group, median time to stenting was 72.8 hours.
Six patients from the delayed-stenting group were transferred to the immediate-stenting group after random assignment because of safety concerns or because of how dissection progressed. There were no urgent revascularization or major bleeding events during the delay period.
In the intention-to-treat analysis, there was no significant difference between the groups in infarct size (delayed-stenting group, 15%; immediate-stenting group, 19.4%; P = .112) or microvascular obstruction incidence (delayed-stenting group, 42.6%; immediate-stenting group, 57.4%; P = .196).
However, in patients with anterior wall MI (n = 69), delayed stenting was associated with reduced infarct size (16.1% vs. 22.7%; P = .017) and microvascular obstruction incidence (43.8% vs. 70.3%; P = .043).
“We speculate that delayed stenting can be beneficial to reduce infarct size and myocardial no-reflow in patients who have large microvascular obstruction–prone conditions, such as large amounts of thrombus burden and large microvascular bed,” Kim and colleagues wrote. – by Erik Swain
Disclosure : The study was supported, in part, by Isu Abxis Co. Ltd. and Terumo Corp. The researchers report no relevant financial disclosures.
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