Possible Advantages of Deferred Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction Patients With Moderate-to-High Thrombus Burden

Primary percutaneous coronary intervention is the standard of care for ST-elevation myocardial infarction (STEMI). However, the proper management of the culprit artery with residual moderate-to-high thrombus burden after the initial restoration of flow is still unclear.
 
One hundred patients with STEMI underwent primary percutaneous coronary intervention, through which the operators managed to establish thrombolysis in myocardial infarction (TIMI) II–III flow with minimal manipulation but with residual moderate-to-high thrombus burden in the culprit artery. The patients were categorized into 2 equal groups. Group A consisted of patients who underwent immediate stenting, and Group B was comprised of patients for whom the intervention was deferred. After 24 to 48 hours, coronary angiography was repeated in Group B, and stenting was done when needed. The patients had pre-discharge echocardiography and were followed for 4 weeks for major adverse cardiac events (MACE); additionally, echocardiography was repeated 1 month after discharge
 
There was no difference between the 2 groups regarding the TIMI flow of the culprit artery at the end of the revascularization procedure. There was a significant difference between the groups concerning the need for coronary stenting, which was lower in the deferral group (100% of the patients had stents in Group A vs 58% in Group B; P = 0.000). No significant difference was observed between the immediate and the deferral groups apropos the in-hospital morbidity/mortality or left ventricular function. At follow-up, there was no difference between the 2 groups vis-à-vis MACE and left ventricular function.
 
Deferred stenting is beneficial in reducing the need for stenting and the associated mortality/morbidity. (Iranian Heart Journal 2021; 22(1): 26-32)