Immediate versus deferred PCI in patients presenting with acute ST Segment elevation myocardial infarction with moderate to high thrombus burden

Abstract

Listen

Translate article

Abstract Background Primary PCI is considered the standard of care treatment for STEMI when timely done. However, the proper management of the culprit artery with moderate to high thrombus burden is still unclear. Objective We sought to compare the outcome of deferred primary PCI in patients presenting with STEMI with moderate to high thrombus burden after a course of intensive dual anti-platelet and IV Glycoprotein IIb/IIIa receptor blockers with immediate PCI. Methods We analyzed the data of 100 patients with STEMI and high or moderate thrombus burden who underwent primary PCI in a prospective nonrandomized case control study. Patients were divided into 2 groups, 50 in each group. The first group(A) included patients who underwent coronary angiography with immediate PCI. While the second group(B) included the patients who were deferred and received dual antiplatelet and Glycoprotein IIb/IIIa receptor blockers .After 24-48 hours, coronary angiogram was repeated and PCI was done when needed. All patients had a pre-discharge echo for assessment and followed up for 4 weeks after discharge for major adverse cardiac events (MACE) Results The baseline data were similar in both groups.There was no statistical difference between both groups as regards the TIMI flow of the culprit artery at the end of the procedure TIMI III was 84% in the groupA and was 86% in group B (P. value = 0.114)). There was a significant difference between both groups for the need of PCI being lower in the deferral group 50 patients had PCI in the group A (100.0%) and 29 patients only had PCI in group B (58.0%), P value = 0.000). Thrombuss aspiration decreased the need for PCI (22 patients out of 35 had PCI from the aspiration group while 58 patients out of 63 had PCI, (P value = 0.001).There was no statistical difference between the immediate and the deferral group as regards the in-hospital morbidity and mortality nor left ventricular functions.At follow up, there was no statistical difference between both groups as regards MACE. Conclusion Deferring PCI in patients with STEMI and high or moderate thrombus burden, did not affect neither the TIMI flow at the end of the procedure nor the in-hospital morbidity or mortality. After 4 weeks.MACE was similar in the deferral and immediate PCI groups.However, deferral carries an advantage of reducing the need for PCI. Thrombus aspiration may enhance the flow in the culprit artery and reduce the need for PCI.