Premium
Deferred or immediate stent implantation for primary percutaneous coronary intervention: A meta‐analysis of randomized trials
Author(s) -
Mahmoud Ahmed N.,
Saad Marwan,
Elgendy Akram Y.,
Mentias Amgad,
Elgendy Islam Y.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27240
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , relative risk , randomized controlled trial , stent , confidence interval , surgery , population , cardiology , myocardial infarction , environmental health
Objectives To perform a meta‐analysis of randomized trials comparing a deferred versus immediate stenting strategy for primary percutaneous coronary intervention (PCI). Background Deferred stent implantation has emerged as a potential strategy aiming to reduce the thrombus burden and improve micro‐vascular reperfusion during primary PCI. Methods Electronic databases were searched for randomized trials that compared a deferred stent implantation versus immediate stent implantation strategy in patients undergoing primary PCI. Random effects risk ratios (RR) were estimated for the outcomes of interest. Results Four trials with 1,570 patients were included. A deferred stent implantation strategy was associated with a lower incidence of no‐/slow reflow (RR 0.49, 95% confidence interval [CI] 0.24‐0.96), and improved myocardial blush grade 3 (RR 1.42, 95% CI 1.14–1.77). At a mean follow up of 34 ± 15 months, both strategies were associated with a similar risk of all‐cause mortality (RR 0.85, 95% CI 0.58–1.24), cardiovascular mortality (RR 0.84, 95% CI 0.48–1.45), reinfarction (RR 1.54, 95% CI 0.43–5.49), and stent thrombosis (RR = 0.35, 95% CI 0.04–3.35, P = 0.36). Conclusion In patients undergoing primary PCI, deferred stent implantation is associated with improvement in surrogate outcomes, but does not appear to improve clinical outcomes. Future randomized trials are encouraged to identify the patient population who might benefit from a deferred stent implantation strategy (e.g., high thrombus burden).