A randomized trial of deferred stenting versus immediate stenting to prevent No- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI)

David Carrick, Keith G. Oldroyd, Margaret McEntegart, Caroline Haig, Mark C. Petrie, Hany Eteiba, Stuart Hood, Colum Owens, Stuart Watkins, Jamie Layland, Mitchell Lindsay, Eileen Peat, Alan Rae, Miles Behan, Arvind Sood, W. Stewart Hillis, Ify Mordi, Ahmed Mahrous, Nadeem Ahmed, Rebekah WilsonLaura Lasalle, Philippe Généreux, Ian Ford, Colin Berry

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Objectives The aim of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Background No-reflow is associated with adverse outcomes in STEMI. Methods This was a prospective, single-center, randomized, controlled, proof-of-concept trial in reperfused STEMI patients with >1 risk factors for no-reflow. Randomization was to deferred stenting with an intention-to-stent 4 to 16 h later or conventional treatment with immediate stenting. The primary outcome was the incidence of no-/slow-reflow (Thrombolysis In Myocardial Infarction ≤2). Cardiac magnetic resonance imaging was performed 2 days and 6 months after myocardial infarction. Myocardial salvage was the final infarct size indexed to the initial area at risk. Results Of 411 STEMI patients (March 11, 2012 to November 21, 2012), 101 patients (mean age, 60 years; 69% male) were randomized (52 to the deferred stenting group, 49 to the immediate stenting). The median (interquartile range [IQR]) time to the second procedure in the deferred stenting group was 9 h (IQR: 6 to 12 h). Fewer patients in the deferred stenting group had no-/slow-reflow (14 [29%] vs. 3 [6%]; p = 0.006), no reflow (7 [14%] vs. 1 [2%]; p = 0.052) and intraprocedural thrombotic events (16 [33%] vs. 5 [10%]; p = 0.010). Thrombolysis In Myocardial Infarction coronary flow grades at the end of PCI were higher in the deferred stenting group (p = 0.018). Recurrent STEMI occurred in 2 patients in the deferred stenting group before the second procedure. Myocardial salvage index at 6 months was greater in the deferred stenting group (68 [IQR: 54% to 82%] vs. 56 [IQR: 31% to 72%]; p = 0.031]. Conclusions In high-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573)

Original languageEnglish (US)
Pages (from-to)2088-2098
Number of pages11
JournalJournal of the American College of Cardiology
Volume63
Issue number20
DOIs
StatePublished - May 27 2014
Externally publishedYes

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Percutaneous Coronary Intervention
Myocardial Infarction
Stents
Random Allocation
ST Elevation Myocardial Infarction
Myocardium
Magnetic Resonance Imaging
Incidence
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Carrick, David ; Oldroyd, Keith G. ; McEntegart, Margaret ; Haig, Caroline ; Petrie, Mark C. ; Eteiba, Hany ; Hood, Stuart ; Owens, Colum ; Watkins, Stuart ; Layland, Jamie ; Lindsay, Mitchell ; Peat, Eileen ; Rae, Alan ; Behan, Miles ; Sood, Arvind ; Hillis, W. Stewart ; Mordi, Ify ; Mahrous, Ahmed ; Ahmed, Nadeem ; Wilson, Rebekah ; Lasalle, Laura ; Généreux, Philippe ; Ford, Ian ; Berry, Colin. / A randomized trial of deferred stenting versus immediate stenting to prevent No- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI). In: Journal of the American College of Cardiology. 2014 ; Vol. 63, No. 20. pp. 2088-2098.
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title = "A randomized trial of deferred stenting versus immediate stenting to prevent No- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI)",
abstract = "Objectives The aim of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Background No-reflow is associated with adverse outcomes in STEMI. Methods This was a prospective, single-center, randomized, controlled, proof-of-concept trial in reperfused STEMI patients with >1 risk factors for no-reflow. Randomization was to deferred stenting with an intention-to-stent 4 to 16 h later or conventional treatment with immediate stenting. The primary outcome was the incidence of no-/slow-reflow (Thrombolysis In Myocardial Infarction ≤2). Cardiac magnetic resonance imaging was performed 2 days and 6 months after myocardial infarction. Myocardial salvage was the final infarct size indexed to the initial area at risk. Results Of 411 STEMI patients (March 11, 2012 to November 21, 2012), 101 patients (mean age, 60 years; 69{\%} male) were randomized (52 to the deferred stenting group, 49 to the immediate stenting). The median (interquartile range [IQR]) time to the second procedure in the deferred stenting group was 9 h (IQR: 6 to 12 h). Fewer patients in the deferred stenting group had no-/slow-reflow (14 [29{\%}] vs. 3 [6{\%}]; p = 0.006), no reflow (7 [14{\%}] vs. 1 [2{\%}]; p = 0.052) and intraprocedural thrombotic events (16 [33{\%}] vs. 5 [10{\%}]; p = 0.010). Thrombolysis In Myocardial Infarction coronary flow grades at the end of PCI were higher in the deferred stenting group (p = 0.018). Recurrent STEMI occurred in 2 patients in the deferred stenting group before the second procedure. Myocardial salvage index at 6 months was greater in the deferred stenting group (68 [IQR: 54{\%} to 82{\%}] vs. 56 [IQR: 31{\%} to 72{\%}]; p = 0.031]. Conclusions In high-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573)",
author = "David Carrick and Oldroyd, {Keith G.} and Margaret McEntegart and Caroline Haig and Petrie, {Mark C.} and Hany Eteiba and Stuart Hood and Colum Owens and Stuart Watkins and Jamie Layland and Mitchell Lindsay and Eileen Peat and Alan Rae and Miles Behan and Arvind Sood and Hillis, {W. Stewart} and Ify Mordi and Ahmed Mahrous and Nadeem Ahmed and Rebekah Wilson and Laura Lasalle and Philippe G{\'e}n{\'e}reux and Ian Ford and Colin Berry",
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month = "5",
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doi = "10.1016/j.jacc.2014.02.530",
language = "English (US)",
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pages = "2088--2098",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
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Carrick, D, Oldroyd, KG, McEntegart, M, Haig, C, Petrie, MC, Eteiba, H, Hood, S, Owens, C, Watkins, S, Layland, J, Lindsay, M, Peat, E, Rae, A, Behan, M, Sood, A, Hillis, WS, Mordi, I, Mahrous, A, Ahmed, N, Wilson, R, Lasalle, L, Généreux, P, Ford, I & Berry, C 2014, 'A randomized trial of deferred stenting versus immediate stenting to prevent No- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI)', Journal of the American College of Cardiology, vol. 63, no. 20, pp. 2088-2098. https://doi.org/10.1016/j.jacc.2014.02.530

A randomized trial of deferred stenting versus immediate stenting to prevent No- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI). / Carrick, David; Oldroyd, Keith G.; McEntegart, Margaret; Haig, Caroline; Petrie, Mark C.; Eteiba, Hany; Hood, Stuart; Owens, Colum; Watkins, Stuart; Layland, Jamie; Lindsay, Mitchell; Peat, Eileen; Rae, Alan; Behan, Miles; Sood, Arvind; Hillis, W. Stewart; Mordi, Ify; Mahrous, Ahmed; Ahmed, Nadeem; Wilson, Rebekah; Lasalle, Laura; Généreux, Philippe; Ford, Ian; Berry, Colin.

In: Journal of the American College of Cardiology, Vol. 63, No. 20, 27.05.2014, p. 2088-2098.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A randomized trial of deferred stenting versus immediate stenting to prevent No- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI)

AU - Carrick, David

AU - Oldroyd, Keith G.

AU - McEntegart, Margaret

AU - Haig, Caroline

AU - Petrie, Mark C.

AU - Eteiba, Hany

AU - Hood, Stuart

AU - Owens, Colum

AU - Watkins, Stuart

AU - Layland, Jamie

AU - Lindsay, Mitchell

AU - Peat, Eileen

AU - Rae, Alan

AU - Behan, Miles

AU - Sood, Arvind

AU - Hillis, W. Stewart

AU - Mordi, Ify

AU - Mahrous, Ahmed

AU - Ahmed, Nadeem

AU - Wilson, Rebekah

AU - Lasalle, Laura

AU - Généreux, Philippe

AU - Ford, Ian

AU - Berry, Colin

PY - 2014/5/27

Y1 - 2014/5/27

N2 - Objectives The aim of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Background No-reflow is associated with adverse outcomes in STEMI. Methods This was a prospective, single-center, randomized, controlled, proof-of-concept trial in reperfused STEMI patients with >1 risk factors for no-reflow. Randomization was to deferred stenting with an intention-to-stent 4 to 16 h later or conventional treatment with immediate stenting. The primary outcome was the incidence of no-/slow-reflow (Thrombolysis In Myocardial Infarction ≤2). Cardiac magnetic resonance imaging was performed 2 days and 6 months after myocardial infarction. Myocardial salvage was the final infarct size indexed to the initial area at risk. Results Of 411 STEMI patients (March 11, 2012 to November 21, 2012), 101 patients (mean age, 60 years; 69% male) were randomized (52 to the deferred stenting group, 49 to the immediate stenting). The median (interquartile range [IQR]) time to the second procedure in the deferred stenting group was 9 h (IQR: 6 to 12 h). Fewer patients in the deferred stenting group had no-/slow-reflow (14 [29%] vs. 3 [6%]; p = 0.006), no reflow (7 [14%] vs. 1 [2%]; p = 0.052) and intraprocedural thrombotic events (16 [33%] vs. 5 [10%]; p = 0.010). Thrombolysis In Myocardial Infarction coronary flow grades at the end of PCI were higher in the deferred stenting group (p = 0.018). Recurrent STEMI occurred in 2 patients in the deferred stenting group before the second procedure. Myocardial salvage index at 6 months was greater in the deferred stenting group (68 [IQR: 54% to 82%] vs. 56 [IQR: 31% to 72%]; p = 0.031]. Conclusions In high-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573)

AB - Objectives The aim of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Background No-reflow is associated with adverse outcomes in STEMI. Methods This was a prospective, single-center, randomized, controlled, proof-of-concept trial in reperfused STEMI patients with >1 risk factors for no-reflow. Randomization was to deferred stenting with an intention-to-stent 4 to 16 h later or conventional treatment with immediate stenting. The primary outcome was the incidence of no-/slow-reflow (Thrombolysis In Myocardial Infarction ≤2). Cardiac magnetic resonance imaging was performed 2 days and 6 months after myocardial infarction. Myocardial salvage was the final infarct size indexed to the initial area at risk. Results Of 411 STEMI patients (March 11, 2012 to November 21, 2012), 101 patients (mean age, 60 years; 69% male) were randomized (52 to the deferred stenting group, 49 to the immediate stenting). The median (interquartile range [IQR]) time to the second procedure in the deferred stenting group was 9 h (IQR: 6 to 12 h). Fewer patients in the deferred stenting group had no-/slow-reflow (14 [29%] vs. 3 [6%]; p = 0.006), no reflow (7 [14%] vs. 1 [2%]; p = 0.052) and intraprocedural thrombotic events (16 [33%] vs. 5 [10%]; p = 0.010). Thrombolysis In Myocardial Infarction coronary flow grades at the end of PCI were higher in the deferred stenting group (p = 0.018). Recurrent STEMI occurred in 2 patients in the deferred stenting group before the second procedure. Myocardial salvage index at 6 months was greater in the deferred stenting group (68 [IQR: 54% to 82%] vs. 56 [IQR: 31% to 72%]; p = 0.031]. Conclusions In high-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573)

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