title: Deferred vs immediate stenting in ST elevation myocardial infarction: Potential interest in selected patients.
abstract: BACKGROUND
  Slow flow, no reflow and distal embolization often occur during primary angioplasty in ST segment elevation myocardial infarction (STEMI), compromising optimal myocardial reperfusion.
  
  
  OBJECTIVE
  This study aimed at assessing the impact of deferred stenting (DS) on periprocedural events as compared to immediate stenting (IS). The second objective was to gather the reasons advocated by the physicians for deferring stenting.
  
  
  METHODS
  All consecutive patients referred for primary angioplasty were included between September 2010 and November 2011. Physicians were free to choose the strategy between DS and IS but had to justify their choice. DS patients underwent a coronary angiogram control in a delay > 24h.
  
  
  RESULTS
  Ninety-eight patients were included. Forty patients underwent DS and 58 IS. DS strategy involved thrombus management by thromboaspiration (33 patients 82.5%) and by the use of AntiGpIIbIIIa (23 patients 62.2%). This strategy could be achieved with a low complication rate. In particular, one patient had a reocclusion leading to a rapid reintervention and one had a distal embolization. In comparison, 11 periprocedural events occurred in the IS subgroup. In addition, among DS patients, 7 were treated medically because of a non-significant stenosis. The major criteria considered by the operator to prefer DS in the presence of a TIMI 3 flow concerned thrombotic load.
  
  
  CONCLUSIONS
  This mono-centric experience confirmed the feasibility and the safety of DS. On top of reducing periprocedural events, it may allow for other treatment options in selected STEMI patients, e.g. surgery or medical treatment. The reasons leading physicians to choose DS were large thrombus burden on top of resolution of chest pain and normalization of the ECG. These criteria could help selecting situations in which DS may be of particular value as compared to IS.
authors.affiliation: Hospices civils de Lyon, hôpital de la Croix-Rousse, European Society of Hypertension Excellence Center, Cardiology Department, 69004 Lyon, France; Université Lyon-1, 69100 Villeurbanne, France; Génomique fonctionnelle de l'hypertension artérielle, 69008 Lyon, France; Hôpital Nord Ouest, 69400 Villefranche-sur-Saône, France. Electronic address: bharbaoui@gmail.com.
authors.forename: Brahim
authors.initials: B
authors.lastname: Harbaoui
authors.affiliation: Hospices civils de Lyon, hôpital de la Croix-Rousse, European Society of Hypertension Excellence Center, Cardiology Department, 69004 Lyon, France; Université Lyon-1, 69100 Villeurbanne, France; Génomique fonctionnelle de l'hypertension artérielle, 69008 Lyon, France; Hôpital Nord Ouest, 69400 Villefranche-sur-Saône, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Courand
authors.affiliation: Hospices civils de Lyon, hôpital de la Croix-Rousse, European Society of Hypertension Excellence Center, Cardiology Department, 69004 Lyon, France; Université Lyon-1, 69100 Villeurbanne, France; Génomique fonctionnelle de l'hypertension artérielle, 69008 Lyon, France; Hôpital Nord Ouest, 69400 Villefranche-sur-Saône, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Besnard
authors.affiliation: Hospices civils de Lyon, hôpital de la Croix-Rousse, European Society of Hypertension Excellence Center, Cardiology Department, 69004 Lyon, France; Université Lyon-1, 69100 Villeurbanne, France; Génomique fonctionnelle de l'hypertension artérielle, 69008 Lyon, France; Hôpital Nord Ouest, 69400 Villefranche-sur-Saône, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Dauphin
authors.affiliation: Hospices civils de Lyon, hôpital de la Croix-Rousse, European Society of Hypertension Excellence Center, Cardiology Department, 69004 Lyon, France; Université Lyon-1, 69100 Villeurbanne, France; Génomique fonctionnelle de l'hypertension artérielle, 69008 Lyon, France; Hôpital Nord Ouest, 69400 Villefranche-sur-Saône, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cassar
authors.affiliation: Hospices civils de Lyon, hôpital de la Croix-Rousse, European Society of Hypertension Excellence Center, Cardiology Department, 69004 Lyon, France; Université Lyon-1, 69100 Villeurbanne, France; Génomique fonctionnelle de l'hypertension artérielle, 69008 Lyon, France; Hôpital Nord Ouest, 69400 Villefranche-sur-Saône, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lantelme
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology; D015897:Comorbidity; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000473:pathology / Q000628:therapy; D004562:Electrocardiography; D004617:Embolism / Q000209:etiology / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D054318:No-Reflow Phenomenon / Q000209:etiology / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010820:Physicians / Q000523:psychology; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality; D015607:Stents; D017131:Thrombectomy; D013997:Time Factors
chemical_list: D002317:Cardiovascular Agents