A Randomized Trial of Deferred Stenting Versus Immediate Stenting to Prevent No- or Slow-Reflow in Acute ST-Segment Elevation Myocardial Infarction (DEFER-STEMI)

被引：228

作者：

Carrick, David ^{[1
,2
]}

Oldroyd, Keith G. ^{[1
]}

McEntegart, Margaret ^{[2
]}

Haig, Caroline ^{[3
]}

Petrie, Mark C. ^{[1
]}

Eteiba, Hany ^{[1
]}

Hood, Stuart ^{[1
]}

Owens, Colum ^{[1
]}

Watkins, Stuart ^{[1
]}

Layland, Jamie ^{[1
,2
]}

Lindsay, Mitchell ^{[1
]}

Peat, Eileen ^{[1
]}

Rae, Alan ^{[2
]}

Behan, Miles ^{[4
]}

Sood, Arvind ^{[5
]}

Hillis, W. Stewart ^{[1
]}

Mordi, Ify ^{[1
,2
]}

Mahrous, Ahmed ^{[2
]}

Ahmed, Nadeem

Wilson, Rebekah

Lasalle, Laura ^{[6
,7
]}

Genereux, Philippe ^{[6
,7
]}

Ford, Ian ^{[3
]}

Berry, Colin ^{[1
,2
]}

机构：

[1] Univ Glasgow, BHF Glasgow Cardiovasc Res Ctr, Inst Cardiovasc & Med Sci, Glasgow G12 8TA, Lanark, Scotland

[2] Golden Jubilee Natl Hosp, West Scotland Heart & Lung Ctr, Glasgow, Dunbartan, Scotland

[3] Univ Glasgow, Robertson Ctr Biostat, Glasgow G12 8TA, Lanark, Scotland

[4] Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland

[5] Hairmyres Hosp, E Kilbride, Lanark, Scotland

[6] Cardiovasc Res Fdn, New York, NY USA

[7] Columbia Univ, Med Ctr, New York, NY USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2014年 / 63卷 / 20期

关键词：

deferred stenting; myocardial infarction; myocardial salvage; no-reflow; primary percutaneous coronary intervention; PERCUTANEOUS CORONARY INTERVENTION; THROMBUS ASPIRATION; PRIMARY ANGIOPLASTY; MAGNETIC-RESONANCE; TASK-FORCE; THROMBECTOMY; PERFUSION; SOCIETY; IMPACT;

D O I：

10.1016/j.jacc.2014.02.530

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Background No-reflow is associated with adverse outcomes in STEMI. Methods This was a prospective, single-center, randomized, controlled, proof-of-concept trial in reperfused STEMI patients with >= 1 risk factors for no-reflow. Randomization was to deferred stenting with an intention-to-stent 4 to 16 h later or conventional treatment with immediate stenting. The primary outcome was the incidence of no-/slow-reflow (Thrombolysis In Myocardial Infarction <= 2). Cardiac magnetic resonance imaging was performed 2 days and 6 months after myocardial infarction. Myocardial salvage was the final infarct size indexed to the initial area at risk. Results Of 411 STEMI patients (March 11, 2012 to November 21, 2012), 101 patients (mean age, 60 years; 69% male) were randomized (52 to the deferred stenting group, 49 to the immediate stenting). The median (interquartile range [IQR]) time to the second procedure in the deferred stenting group was 9 h (IQR: 6 to 12 h). Fewer patients in the deferred stenting group had no-/slow-reflow (14 [29%] vs. 3 [6%]; p = 0.006), no reflow (7 [14%] vs. 1 [2%]; p = 0.052) and intraprocedural thrombotic events (16 [33%] vs. 5 [10%]; p 0.010). Thrombolysis In Myocardial Infarction coronary flow grades at the end of PCI were higher in the deferred stenting group (p = 0.018). Recurrent STEMI occurred in 2 patients in the deferred stenting group before the second procedure. Myocardial salvage index at 6 months was greater in the deferred stenting group (68 [IQR: 54% to 82%] vs. 56 [IQR: 31% to 72%]; p = 0.031]. Conclusions In high-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573) (c) 2014 by the American College of Cardiology Foundation

引用

页码：2088 / 2098

页数：11

共 31 条

[11] Incidence and Outcomes of No-Reflow Phenomenon During Percutaneous Coronary Intervention Among Patients With Acute Myocardial Infarction [J].

Harrison, Robert W. ;

Aggarwal, Atul ;

Ou, Fang-shu ;

Klein, Lloyd W. ;

Rumsfeld, John S. ;

Roe, Matthew T. ;

Wang, Tracy Y. .

AMERICAN JOURNAL OF CARDIOLOGY, 2013, 111 (02) :178-184

[12] COMPARISON OF COMPLICATIONS DURING PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY FROM 1977 TO 1981 AND FROM 1985 TO 1986 - THE NATIONAL-HEART-LUNG-AND-BLOOD-INSTITUTE PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY REGISTRY [J].

HOLMES, DR ;

HOLUBKOV, R ;

VLIETSTRA, RE ;

KELSEY, SF ;

REEDER, GS ;

DORROS, G ;

WILLIAMS, DO ;

COWLEY, MJ ;

FAXON, DP ;

KENT, KM ;

BENTIVOGLIO, LG ;

DETRE, K .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1988, 12 (05) :1149-1155

[13] A new approach of primary angioplasty for ST-elevation acute myocardial infarction based on minimalist immediate mechanical intervention [J].

Isaaz, Karl ;

Robin, Christophe ;

Cerisier, Alexis ;

Lamaud, Michel ;

Richard, Laure ;

Da Costa, Antoine ;

Sabry, Mohamed Hassan ;

Gerenton, Claude ;

Blanc, Jean Louis .

CORONARY ARTERY DISEASE, 2006, 17 (03) :261-269

[14] Microvascular obstruction and the no-reflow phenomenon after percutaneous coronary intervention [J].

Jaffe, Ronen ;

Charron, Thierry ;

Puley, Geoffrey ;

Dick, Alexander ;

Strauss, Bradley H. .

CIRCULATION, 2008, 117 (24) :3152-3156

[15] Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials [J].

Keeley, EC ;

Boura, JA ;

Grines, CL .

LANCET, 2003, 361 (9351) :13-20

[16] Deferred stent implantation in patients with ST-segment elevation myocardial infarction: a pilot study [J].

Kelbaek, Henning ;

Engstrom, Thomas ;

Ahtarovski, Kiril A. ;

Lonborg, Jacob ;

Vejlstrup, Niels ;

Pedersen, Frants ;

Holmvang, Lene ;

Helqvist, Steffen ;

Saunamaki, Kari ;

Jorgensen, Erik ;

Clemmensen, Peter ;

Klovgaard, Lene ;

Tilsted, Hans-Henrik ;

Raungaard, Bent ;

Ravkilde, Jan ;

Aaroe, Jens ;

Eggert, Svend ;

Kober, Lars .

EUROINTERVENTION, 2013, 8 (10) :1126-1133

[17] Phase-sensitive inversion recovery for detecting myocardial infarction using gadolinium-delayed hyperenhancement [J].

Kellman, P ;

Arai, AE ;

McVeigh, ER ;

Aletras, AH .

MAGNETIC RESONANCE IN MEDICINE, 2002, 47 (02) :372-383

[18] Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols [J].

Kramer, Christopher M. ;

Barkhausen, Jorg ;

Flamm, Scott D. ;

Kim, Raymond J. ;

Nagel, Eike .

JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE, 2008, 10 (1)

[19] 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions [J].

Levine, Glenn N. ;

Bates, Eric R. ;

Blankenship, James C. ;

Bailey, Steven R. ;

Bittl, John A. ;

Cercek, Bojan ;

Chambers, Charles E. ;

Ellis, Stephen G. ;

Guyton, Robert A. ;

Hollenberg, Steven M. ;

Khot, Umesh N. ;

Lange, Richard A. ;

Mauri, Laura ;

Mehran, Roxana ;

Moussa, Issam D. ;

Mukherjee, Debabrata ;

Nallamothu, Brahmajee K. ;

Ting, Henry H. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2011, 58 (24) :E44-E122

[20] Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Are Associated With Adverse Outcomes [J].

McEntegart, Margaret B. ;

Kirtane, Ajay J. ;

Cristea, Ecaterina ;

Brener, Sorin ;

Mehran, Roxana ;

Fahy, Martin ;

Moses, Jeffrey W. ;

Stone, Gregg W. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2012, 59 (20) :1745-1751

← 1 2 3 4 →