Mitigating the risk of flow deterioration by deferring stent optimization in STEMI patients with large thrombus burden: Insights from a prospective cohort study

Objectives It is uncertain, if omitting post-dilatation and stent oversizing (stent optimization) is safe and may decrease the risk for distal thrombus embolization (DTE) in STEMI patients with large thrombus burden (LTB). Background In patients with ST-segment elevation myocardial infarction (STEMI...

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Vydáno v:BMC cardiovascular disorders Ročník 23; číslo 1; s. 1 - 11
Hlavní autoři: Cioffi, Giacomo Maria, Zhi, Yuan, Madanchi, Mehdi, Seiler, Thomas, Stutz, Leah, Gjergjizi, Varis, Romero, Jean-Paul, Attinger-Toller, Adrian, Bossard, Matthias, Cuculi, Florim
Médium: Journal Article
Jazyk:angličtina
Vydáno: London BioMed Central 12.10.2023
BioMed Central Ltd
Springer Nature B.V
BMC
Témata:
Angiology
Angioplasty
Anticoagulants
Blood clot
Blood clots
Blood Transfusion Medicine
Cardiac Surgery
Cardiology
Care and treatment
Clinical outcomes
Cohort analysis
Embolization
Evaluation
Heart attack
Heart attacks
Implants
Internal Medicine
Medical imaging
Medicine
Medicine & Public Health
Methods
Myocardial infarction
No-reflow
Optical coherence tomography
Optimization techniques
STEMI
Stent (Surgery)
Stent optimization
Stents
Thrombosis
Switzerland
Myocardial infarction
STEMI
No-reflow
Stent optimization
Optical coherence tomography
ISSN:1471-2261, 1471-2261
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Shrnutí:Objectives It is uncertain, if omitting post-dilatation and stent oversizing (stent optimization) is safe and may decrease the risk for distal thrombus embolization (DTE) in STEMI patients with large thrombus burden (LTB). Background In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) with stenting, (DTE) and flow deterioration are common and increase infarct size leading to worse outcomes. Methods From a prospective registry, 74 consecutive STEMI patients with LTB undergoing pPCI with stenting and intentionally deferred stent optimization were analyzed. Imaging data and outcomes up to 2 years follow-up were analyzed. Results Overall, 74 patients (18% females) underwent deferred stent optimization. Direct stenting was performed in 13 (18%) patients. No major complications occurred during pPCI. Staged stent optimization was performed after a median of 4 (interquartile range (IQR) 3; 7) days. On optical coherence tomography, under-expansion and residual thrombus were present in 59 (80%) and 27 (36%) cases, respectively. During deferred stent optimization, we encountered no case of flow deterioration (slow or no-reflow) or side branch occlusion. Minimal lumen area (mm 2 ) and stent expansion (%) were corrected from 4.87±1.86mm to 6.82±2.36mm ( p <0.05) and from 69±18% to 91±12% ( p <0.001), respectively. During follow-up, 1 patient (1.4%) required target lesion revascularization and 1 (1.4%) patient succumbed from cardiovascular death. Conclusions Among STEMI patients with LTB, deferring stent optimization in the setting of pPCI appears safe and potentially mitigates the risk of DTE. The impact of this approach on infarct size and clinical outcomes warrants further investigation in a dedicated trial.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1471-2261
1471-2261
DOI:10.1186/s12872-023-03540-0