Non-stenting strategy is not inferior to stent implantation in patients with acute ST-segment elevated myocardial infarction and high thrombus burden and intermediate stenotic culprit lesion

作者：Demou Luo, Xing Yang, Xiangming Hu, Jixin Liu, Chenyang Wang, Jingguang Ye, Xiaosheng Guo, Shenghui Xu, Boyu Sun, Yongdong Liu, Shuo Sun, Yingling Zhou, Zheng Huang, Youti Zhang, Haojian Dong · 发表于：Annals of Palliative Medicine · 年份：2021 · DOI：10.21037/apm-21-2612 · 被引用次数：8 · 研究领域：Coronary Interventions and Diagnostics、Acute Myocardial Infarction Research、Antiplatelet Therapy and Cardiovascular Diseases

BACKGROUND: According to European Society of Cardiology (ESC) as well as American College of Cardiology/American Heart Association (ACC/AHA) guidelines, primary stenting is recommended for patients with acute ST-segment elevation myocardial infarction (STEMI); however, in-stent thrombosis is a life-threatening early adverse event that could lead to acute myocardial infarction (AMI) or even cardiac death. On the other hand, in-stent restenosis is a late adverse event that could result in recurrent readmission and revascularization. We compared a non-stenting (NS) strategy to a stenting (S) strategy in terms of incidence of major adverse cardiac events (MACEs) for patients with acute STEMI and high thrombus burden. METHODS: We performed a post hoc analysis of our prior multicenter, prospective cohort study (ChiCTR1800019923) among 51 eligible patients with acute STEMI and high thrombus burden. All participants received percutaneous coronary intervention (PCI) with a deferred-stenting strategy (second procedure performed within 48-72 h after primary PCI). Either NS or S strategies were carried out among patients. Primary outcomes were follow-ups of MACEs at 1, 3, 6, and 12 months. Intravenous ultrasound (IVUS) and quantitative flow ratio (QFR) evaluation were performed. RESULTS: In our post hoc analysis of 51 patients (21 with NS and 30 with S), baseline clinical and interventional characteristics were well matched between the 2 groups, to the exception of culprit lesion length....