Meta-Analysis Compares Deferred or Immediate Stent Implantation for Primary PCI

August 21, 2017—In Catheterization and Cardiovascular Interventions, Ahmed N. Mahmoud, MD, et al published findings from a meta-analysis of randomized trials comparing a deferred versus immediate stenting strategy for primary percutaneous coronary intervention (PCI). The investigators noted that deferred stent implantation has emerged as a potential strategy aiming to reduce the thrombus burden and improve microvascular reperfusion during primary PCI.

As summarized in Catheterization and Cardiovascular Interventions, the investigators searched electronic databases for randomized trials that compared a deferred stent implantation versus immediate stent implantation strategy in patients undergoing primary PCI. Random effects risk ratios (RR) were estimated for the outcomes of interest.

The analysis included four trials with 1,570 patients. A deferred stent implantation strategy was associated with a lower incidence of no/slow reflow (RR, 0.49; 95% confidence interval [CI], 0.24–0.96) and improved myocardial blush grade 3 (RR, 1.42; 95% CI, 1.14–1.77).

The investigators reported that at a mean follow-up of 34 ± 15 months, both strategies were associated with a similar risk of all-cause mortality (RR, 0.85, 95% CI, 0.58–1.24), cardiovascular mortality (RR, 0.84; 95% CI, 0.48–1.45), reinfarction (RR, 1.54; 95% CI, 0.43–5.49), and stent thrombosis (RR, 0.35; 95% CI, 0.04–3.35; P = .36).

In patients undergoing primary PCI, deferred stent implantation is associated with improvement in surrogate outcomes, but does not appear to improve clinical outcomes. Future randomized trials are encouraged to identify the patient population who might benefit from a deferred stent implantation strategy (eg, high thrombus burden), concluded the investigators in Catheterization and Cardiovascular Interventions.