Delayed vs. immediate stenting in STEMI with ahigh thrombus burden : Asystematic review and meta-analysis.

Abstract

The results of several large-scale randomized controlled trials are controversial regarding the advantages of delayed stenting (DS) compared with immediate stenting (IS). We sought to determine whether DS has benefits for patients with ST-segment elevation myocardial infarction (STEMI) with ahigh thrombus burden compared with IS. We systematically searched fourelectronic databases. Thrombolysis in Myocardial Infarction (TIMI) grade3 flow, TIMI myocardial blush grade (TMBG), complete ST-segment resolution (>70%), major adverse cardiac events (MACE), and major bleeding complications were studied as outcomes. Data analysis was performed using arandom-effects model utilizing the Review Manager5.3 software. Our meta-analysis included eightstudies involving 744patients. DS showed greater benefits than IS in terms of TIMI grade3 flow (odds ratio [OR]: 5.09, 95% confidence interval [CI]: 1.98-13.02, p < 0.001), TMBG (OR:4.17, 95% CI: 1.87-9.31, p < 0.001), complete ST-segment resolution (OR:2.16, 95% CI: 1.36-3.43, p = 0.001), and MACE (OR:0.48, 95% CI: 0.25-0.94, p = 0.03). No significant difference was observed regarding major bleeding events (OR:1.76, 95% CI: 0.40-7.66, p = 0.45). DS yielded satisfactory outcomes regarding myocardial tissue reperfusion, demonstrated by the improved TIMI flow grade, TMBG, complete ST-segment resolution, and decreased MACEs without increasing major bleeding events in patients with STEMI and ahigh thrombus burden. DS may be preferred to IS for treating patients with this characteristic presentation.