title: Immediate versus delayed angioplasty in infarct-related arteries with TIMI III flow and ST segment recovery: a matched comparison in acute myocardial infarction patients.
abstract: BACKGROUND
  Early management of patients with patent infarct-related artery (IRA) and optimal ST resolution in ST elevation myocardial infarction (STEMI) has never been assessed. We compared immediate vs delayed PCI in these patients.
  
  
  METHODS
  Matched comparison of immediate vs delayed (24 h) PCI in STEMI patients presenting with patent IRA, thrombus-containing lesion and ST resolution >or=70%. Patients were matched for duration of symptoms, intervention type, angiographic data, diabetes. Patients in immediate PCI group received standard therapy in the cathlab. Patients in delayed PCI group received dual antiplatelet therapy, antithrombins, and GPIIb-IIIa inhibitors until PCI. Primary endpoint was procedural success. Secondary endpoints were enzyme release and in-hospital adverse events.
  
  
  RESULTS
  Seventy-eight patients were included: 39 per group. Average age 62 years, 75% males. There was a significantly higher procedural success rate in the delayed PCI group (95% success, Vs. 77% in the immediate group, P = 0.008). Initial thrombus burden score did not differ between immediate and delayed PCI groups, but improved significantly in the delayed group between baseline angiography and time of PCI (P = 0.039). There was no difference in major adverse events or bleeding complications between groups. Peak CK levels were significantly higher in the immediate versus delayed PCI group (P = 0.02), although there was no difference between groups in peak CK-MB, peak troponin, or peak CK-MB ratio.
  
  
  CONCLUSIONS
  Our data suggest that in STEMI patients with patent IRA, optimal ST-segment resolution, and thrombus-containing lesion, deferred PCI when patients are given dual antiplatelet therapy, antithrombin agents, and GPIIb-IIIa inhibitors results in a higher procedural success rate, without an increased risk of MACE.
authors.affiliation: Department of Cardiology, University Hospital Jean Minjoz, Besançon, France. nicolas.meneveau@univ-fcomte.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
authors.forename: Marie France
authors.initials: MF
authors.lastname: Séronde
authors.forename: Vincent
authors.initials: V
authors.lastname: Descotes-Genon
authors.forename: Joanna
authors.initials: J
authors.lastname: Dutheil
authors.forename: Romain
authors.initials: R
authors.lastname: Chopard
authors.forename: Fiona
authors.initials: F
authors.lastname: Ecarnot
authors.forename: Florent
authors.initials: F
authors.lastname: Briand
authors.forename: Yvette
authors.initials: Y
authors.lastname: Bernard
authors.forename: François
authors.initials: F
authors.lastname: Schiele
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bassand
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000991:Antithrombins / Q000627:therapeutic use*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex