Delayed stent implantation in acute ST-segment elevation myocardial infarction patients with high thrombus burden in primary percutaneous coronary intervention

Abstract

Objective To evaluate the changes of target lesions and delayed stent implantation after primary percutaneous coronary intervention (PCI) in high thrombus burden patients with acute ST elevation myocardial infarction (STEMI). Methods A total of 48 STEMI patients with high thrombus burden underwent primary PCI were enrolled. After treatment of percutaneous transtuminal coronary angioplasty (PTCA) only and/or catheter aspiration of coronary thrombus, the forward blood flow in infarct-related arteries got thrombolysis in myocardial infarction (TIMI) flow grade 3. All patients accepted coronary angiography (CAG) 7 days after primary PCI and the stenosis of target lesion and delayed stent implantation were evaluated. Data of target lesion changes including degree, length of stenosis, diameter of proximal and distal reference vessel were collected. Stenting proportions were compared between elderly patients (≥60 ys) and young and middle-aged patients (<60 ys). Results Compared with the data of primary PCI, the stenosis degree alleviated (35.5%±14.1% vs. 48.8%±11.1%, P 50% in target lesion. 56% (9/16) of the elderly and 31% (10/32) of the young and middle-aged patients (P=0.04) accepted delayed stent implantation. Conclusions For young and middle-aged STEMI patients with high thrombus burden and unsuitable for primary stenting, the strategy of reperfusing infarct-related artery with primary PTCA and/or catheter aspiration of coronary thrombus, and delayed stenting when necessary is safe and effective. Key words: Myocardial infarction; Angioplasty, transluminal, percutaneous coronary; Infarct-related artery; Stent-delayed implantation