Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2025; 17(2): 99074
Published online Feb 26, 2025. doi: 10.4330/wjc.v17.i2.99074
Outcomes of patients with acute ST-segment elevation myocardial infarction treated by a prolonged “Deferred” percutaneous coronary intervention strategy
Akshyaya Pradhan, Shivam Uppal, Pravesh Vishwakarma, Abhishek Singh, Monika Bhandari, Ayush Shukla, Akhil Sharma, Gaurav Chaudhary, Sharad Chandra, Rishi Sethi, Sudhanshu Kumar Dwivedi
Akshyaya Pradhan, Abhishek Singh, Monika Bhandari, Ayush Shukla, Akhil Sharma, Gaurav Chaudhary, Sharad Chandra, Rishi Sethi, Department of Cardiology, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
Shivam Uppal, Department of Cardiology, Pushpanjali Hospital, Rewari 123401, Haryāna, India
Pravesh Vishwakarma, Sudhanshu Kumar Dwivedi, Cardiology Centre, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
Author contributions: Pradhan A, Uppal S, Vishwakarma P, Singh A, Bhandari M, Shukla A, Sharma A, Chaudhary G, Chandra S, Sethi R, and Dwivedi SK contributed equally to the conceptualization and design, material preparation, writing-draft manuscript, writing-revision, and approved submission of the final version.
Institutional review board statement: The study is approved by the institutional review board (Approval letter no. 503/Ethics/19).
Informed consent statement: Written informed consent was obtained from all participants or their legal guardians.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Dataset will be made available on request by the corresponding author at drmonikab@gmail.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Monika Bhandari, DM, MD, Doctor, Department of Cardiology, King George’s Medical University, Shahmina Road, Chowk, Lucknow 226003, Uttar Pradesh, India. drmonikab@gmail.com
Received: July 12, 2024
Revised: October 8, 2024
Accepted: January 17, 2025
Published online: February 26, 2025
Processing time: 227 Days and 16 Hours
Abstract
BACKGROUND

Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-segment elevation myocardial infarction (STEMI). However, in patients with high thrombus burden, immediate stenting during PCI can lead to poor outcomes due to the risk of thrombus migration and subsequent microvascular occlusion, resulting in no-reflow phenomena. Deferred stenting offers a potential advantage by allowing for the reduction of thrombus load, which may help to minimize the incidence of slow-flow and no-reflow complications. This study explores the effectiveness of a deferred stenting strategy in improving outcomes for STEMI patients.

AIM

To evaluate the effectiveness and safety of deferred PCI in a real-world setting in acute STEMI patients.

METHODS

This study was conducted at King George’s Medical University, Lucknow, from October 1, 2018, to October 30, 2019 and included a total of 55 participants. Patients with acute STEMI who underwent coronary angiography were selected for a deferred PCI strategy based on specific angiographic features.

RESULTS

Anterior wall myocardial infarction was the predominant type of STEMI in 62% of the selected 55 patients (mean age: 54 years; 70% males), and diabetes mellitus was the most common risk factor (18.2%), followed by hypertension (16.2%). On the second angiogram of these patients measures of thrombus grade, thrombolysis in myocardial infarction flow grade, myocardial blush grade, and severity of stenosis of culprit lesion were considerably improved compared to the first angiogram, and the average culprit artery diameter had increased by 7.8%. Most patients (60%) had an uneventful hospital stay during the second angiogram and an uneventful intraprocedural course (85.19%), with slow-flow/no-reflow occurring only in 7.4% of the patients; these patients recovered after taking vasodilator drugs. In 29.3% of patients, the culprit artery was recanalized, preventing unnecessary stent deployment.

CONCLUSION

Deferred PCI strategy is safe and reduces the thrombus burden, improves thrombolysis in myocardial infarction (TIMI) flow, improves myocardial blush grade, and prevents unwarranted stent deployment.

Keywords: Myocardial infarction; Percutaneous coronary intervention; ST elevation myocardial infarction; Stents; Coronary angiography

Core Tip: This study evaluated the effectiveness and safety of a deferred percutaneous coronary intervention (PCI) strategy in patients with ST-segment elevation myocardial infarction (STEMI). The deferred PCI approach led to significant reductions in thrombus burden, improved thrombolysis in myocardial infarction (TIMI) flow, and enhanced myocardial blush grade. It also minimized the incidence of slow-flow/no-flow events and prevented unnecessary stent deployments. These findings suggest that deferred PCI is a promising strategy to manage STEMI patients with high thrombus burden, offering better angiographic and clinical outcomes by optimizing intervention timing and reducing complications.