Minimalist immediate mechanical intervention in acute ST-segment elevation myocardial infarction: is it time to redefine targets?

Delayed vs. immediate stenting in STEMI with a high thrombus burden : A systematic review and meta-analysis

BACKGROUND

The results of several large-scale randomized controlled trials are controversial regarding the advantages of delayed stenting (DS) compared with immediate stenting (IS). We sought to determine whether DS has benefits for patients with ST-segment elevation myocardial infarction (STEMI) with a high thrombus burden compared with IS.

METHODS

We systematically searched four electronic databases. Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow, TIMI myocardial blush grade (TMBG), complete ST-segment resolution (>70%), major adverse cardiac events (MACE), and major bleeding complications were studied as outcomes. Data analysis was performed using a random-effects model utilizing the Review Manager 5.3 software.

RESULTS

Our meta-analysis included eight studies involving 744 patients. DS showed greater benefits than IS in terms of TIMI grade 3 flow (odds ratio [OR]: 5.09, 95% confidence interval [CI]: 1.98-13.02, p < 0.001), TMBG (OR: 4.17, 95% CI: 1.87-9.31, p < 0.001), complete ST-segment resolution (OR: 2.16, 95% CI: 1.36-3.43, p = 0.001), and MACE (OR: 0.48, 95% CI: 0.25-0.94, p = 0.03). No significant difference was observed regarding major bleeding events (OR: 1.76, 95% CI: 0.40-7.66, p = 0.45).

CONCLUSION

DS yielded satisfactory outcomes regarding myocardial tissue reperfusion, demonstrated by the improved TIMI flow grade, TMBG, complete ST-segment resolution, and decreased MACEs without increasing major bleeding events in patients with STEMI and a high thrombus burden. DS may be preferred to IS for treating patients with this characteristic presentation.