Work

Deferred Versus Immediate Stenting in Late-Presenting ST-Segment Elevation Myocardial Infarction (STEMI) Patients With a High Thrombus Burden: A Retrospective Analysis

Year: 2025

Type: article

Abstract: BACKGROUND: Late-presenting patients with ST-segment elevation myocardial infarction (STEMI), defined as those presenting ≥12 hours after symptom onset, represent a high-risk and often underrepresented population. Despite evidence supporting primary percutaneous coronary intervention (PCI) in these patients, those with a high thrombus burden (HTB) face an increased risk of no reflow and adverse outcomes, particularly with immediate stenting. The optimal stent timing in this subgroup remains unclear. METHODS: This retrospective study included 200 patients with late-presenting STEMI and angiographically confirmed HTB. Patients were assigned to either the deferred stenting (DS; n=100) group or the immediate stenting (IS; n=100) group. Clinical and procedural outcomes, including myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) flow, and major adverse cardiovascular events (MACE) at one year, were compared. RESULTS: The DS group was associated with significantly lower no reflow (11 (11%) vs. 26 (26%), p=0.01), less distal embolization (6 (6%) vs. 16 (16%), p=0.04), and higher post-PCI TIMI grade 3 flow (73 (73%) vs. 57 (57%), p=0.03) and MBG 3 (58 (58%) vs. 36 (36%), p=0.01). One-year MACE was significantly reduced in the DS group (7 (7%) vs. 20 (20%), p=0.01). The DS group was independently associated with improved myocardial perfusion and lower MACE. CONCLUSION: In late-presenting STEMI patients with HTB, deferred stenting yielded superior perfusion and clinical outcomes compared to immediate stenting. These findings underscore the importance of individualized stent timing strategies in this high-risk, often overlooked subgroup.

Source: Cureus

DOI: 10.7759/cureus.86317

Authors: Ahmed Hesham Hammad, Mahmoud Abdelaziz Ismaiel, Mohammed H. Abd-Elnaby, Attaa Khaleel Taha, Hamza Kabil

Institutions: Mansoura University, University of Baghdad, Damietta University

Language: English

Topic: Acute Myocardial Infarction Research

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

Funders: Mansoura University, Damietta University