ArticleCureus2025
Deferred Versus Immediate Stenting in Late-Presenting ST-Segment Elevation Myocardial Infarction (STEMI) Patients With a High Thrombus Burden: A Retrospective Analysis.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundLate-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.
methodsThis 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.
resultsThe 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.
conclusionIn 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.
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