Deferred Stenting as an Alternative Strategy for Management of ST-Elevation Myocardial Infarction with Significant Thrombus Burden

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.