Abstract 13101: Improved Angiographic Outcomes With Delayed Stenting Compared With Immediate Stenting for Acute Myocardial Infarction. Evidence From a Meta-analysis
Introduction: High coronary thrombus burden may increase procedural complications, including distal embolization and no re-flow, during percutaneous coronary intervention for acute myocardial infarction (AMI). Some reports have shown benefit with delayed versus immediate stenting in AMI. However, in the absence of definitive randomized controlled trials, data comparing both strategies are limited and optimal timing of stenting in AMI is still debatable.
Methods: We conducted a literature review thru May 2014 for trials comparing immediate versus delayed stenting in both ST-segment and non ST-segment elevation myocardial infarction (NSTEMI). We explored the hypothesis that delayed stenting improves angiographic and clinical outcomes in AMI compared to traditional immediate stenting. We used odds ratio and random effects model for our analysis.
Results: Our search yielded 5 observational and 2 randomized trials including a total of 690 patients. Of these trials, 5 enrolled STEMI patients while 2 enrolled NSTEMI patients. Immediate stenting was associated with increased intra-procedural thrombotic events (Odds ratio (OR) 4.95, 95% confidence interval (CI) [2.43, 10.05]; p<0.0001), no reflow (OR 7.92, 95% CI [2.34, 26.87]; p=0.0009), distal embolization (OR 6.53, 95% CI [2.33, 18.32]; p =0.0004) and post stenting TIMI flow less than 3 (OR 4.63, 95% CI [2.02, 10.65]; p=0.0003), while reinfarction was no different (OR 1.57, 95% CI [0.58, 4.20];p=0.37). Point estimates for death and major bleeding were lower, but not significantly. (death, OR 0.77, 95% CI [0.17, 3.45]; p=0.73, major bleeding, OR 0.48, 95% CI [0.16, 1.43]; p=0.19).
Conclusion: Immediate stenting is associated with significantly more procedural complications, but may result in less bleeding and improved survival. Strategies to reduce intraprocedural complications further as we move towards earlier intervention are needed.
Author Disclosures: R. Nairooz: None. P. Sardar: None. S. Chatterjee: None. S.R. Bapoje: None. S.S. Naidu: None.
- © 2014 by American Heart Association, Inc.