Deferred Stenting in Acute STEMI With Heavy Thrombus Burden

Abstract

T he occurrence of the no-reflow phenomenon during an acute phase of MI has a negative prognostic value. Incomplete coronary reperfusion is associated with a larger infarct size, lower LV ejection fraction, increased mortality, and more frequent congestive heart failure attributable to LV remodeling. Main causes of this phenomenon are not fully understood but the phenomenon has a multifactorial pathogenesis including: distal embolization, ischemia-reperfusion injury, and individual predisposition of coronary microcirculation to injury. Hence many methods were tried for its reversal including pharmacological methods: IC injection calcium channel blocker (verapamil, diltiazem), sodium nitroprusside, glycoprotein IIb/IIIa inhibitors, adenosine, nitroglycerin, intravenous abciximab, papaverine and mechanical methods as: thrombus aspiration, balloon dilatation and stenting the vessel. In our study we tried to assess whether deferred stenting might reduce no reflow and salvage myocardium in primary PCI for STEMI with heavy thrombus burden or not. Our study included 60 acute STEMI patients presented to National Heart Institute. All of them subjected to full history taking, full physical examination, ECG and laboratory tests. All patients received aspirin (325mg) and clopidogrel (600mg) then all of them underwent percutaneous transfemoral coronary angiography then assessment of the thrombus burden then thrombus aspiration using suction device had been done to all patients. After achievement of TIMI III flow, 30 patient underwent 1ry PCI with immediate stent placement and 30 patient transferred to the CCU after achievement of TIMI III flow then treated with intense antiplatelet with GPIIb/IIIa inhibitors then stenting after 24 hours.