British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 10, Issue.: 10
Deferred Stenting as an Alternative Strategy for Management of ST-Elevation Myocardial Infarction with Significant Thrombus Burden
M. Nadeem Attar1*, Ibrahim Bader1, Michael F. Dorsch1, Ben D. Tyrrell1, Raymond Leung1, Neil Brass1, William Hui1 and Po Kee Cheung1 1Department of Cardiology, C. K. Hui Heart Centre, Royal Alexandra Hospital Foundation, 10240, Kingsway, Edmonton, AB T5H 3V9, Canada.
M. Nadeem Attar1*, Ibrahim Bader1, Michael F. Dorsch1, Ben D. Tyrrell1, Raymond Leung1, Neil Brass1, William Hui1 and Po Kee Cheung1
1Department of Cardiology, C. K. Hui Heart Centre, Royal Alexandra Hospital Foundation, 10240, Kingsway, Edmonton, AB T5H 3V9, Canada.
(1) Vijayalakshmi I. Balekundri, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
(2) Oswin Grollmuss, Head of Department of Pediatric and Adult Resuscitation Congenital Heart of Centre Chirurgical Marie Lannelongue, University Paris XI, France.
(1) Anonymous, Dicle University Medicine Faculty, Turkey.
(2) Maythem Saeed, University of San Francisco, California, USA.
Complete Peer review History: http://sciencedomain.org/review-history/11283
Objectives: We evaluate a deferred stenting strategy following intense antithrombotic and antiplatelet therapy as an alternative to primary percutaneous coronary intervention with immediate stenting in ST-Elevation myocardial infarction (STEMI) patients with large thrombus burden.
Methods: We identified all consecutive patients where a deferred stenting strategy was chosen as initial management strategy. Baseline characteristics, clinical outcomes and complications were collected from local and provincial databases. Procedural characteristics were evaluated from detailed review of angiograms.
Results: Between June 2011 and March 2014, thirty eight patients were treated with a deferred stenting strategy. TIMI thrombus grade scale 4 or 5 on the initial angiogram was seen in 82% of cases. Immediate thrombectomy or balloon angioplasty was performed in 25 out of 38 patients to restore flow. Aggressive antithrombotic (86% heparin) and antiplatelet (100% Eptifibatide and 100% dual antiplatelet therapy) was administered. No emergency repeat catheterisation was required. Thirty six patients had a relook angiogram. No further coronary intervention was required in 12/36 (33%) of patients, 23/36 (64%) patients received at least one stent and one patient was sent for coronary bypass surgery. No major bleeding occurred. One patient treated with deferred stenting died at 2 months from stent thrombosis. No other major adverse cardiovascular events occurred.
Discussion: In our experience deferred stenting is safe and has the potential to reduce no reflow and thereby reduce infarct size.
Deferred stenting; primary percutaneous coronary intervention; st-elevation myocardial infarction; glycoprotein 2b/3a inhibitors.
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DOI : 10.9734/BJMMR/2015/20267Review History Comments