title: Delayed Stenting for ST-Elevation Acute Myocardial Infarction in Daily Practice: A Single-Centre Experience.
abstract: The minimalist immediate mechanical intervention (MIMI) strategy aims to restore normal anterograde flow in the culprit artery (by using manual thrombectomy or small-sized balloon predilation) and to defer potential stent implantation. This study evaluated the applicability and midterm clinical results of the MIMI strategy for ST-elevation myocardial infarction (STEMI) management.
  
  
  
  This observational study included consecutive patients admitted for ongoing STEMI (<24 hours' evolution) at 1 institution between June 2010 and June 2013. Revascularization was performed at the physician's discretion. We compared retrospectively "intentional immediate stenting" (standard technique) and "intentional delayed stenting" (MIMI technique).
  
  
  
  Twenty percent of the 279 included patients were treated with the MIMI strategy. These patients were significantly younger and were more frequently men and smokers compared with patients who underwent the standard procedure. The rate of acute reocclusion of the culprit artery related to STEMI in the MIMI group was 1.8%. Drug-eluting stents were used more frequently in the MIMI group (52% vs 27% in the standard group; P < 0.001). The culprit lesion was stented less frequently in the patients treated with MIMI compared with patients in the other group (28.5% vs 9%; P < 0.001). The 1-year actuarial survival free from major adverse cardiovascular events was higher in the MIMI group than in the standard group (96.3% ± 1.8% vs 83.8% ± 2.5%; P = 0.01).
  
  
  
  The MIMI strategy can be applied in selected patients with STEMI. In our centre, this strategy is associated with less systematic culprit lesion stenting and more implantation of drug-eluting stents. However, this needs to be evaluated further in a randomized trial.
authors.affiliation: Cardiology Department, Centre Hospitalier Le Raincy-Montfermeil, Montfermeil, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Pascal
authors.affiliation: Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Veugeois
authors.affiliation: Cardiology Department, CHU Antoine Beclère, Clamart, France; Cardiology Department, Centre Marie Lannelongue, LePlessis Robinson, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Slama
authors.affiliation: Cardiology Department, Centre Marie Lannelongue, LePlessis Robinson, France.
authors.forename: Saliah
authors.initials: S
authors.lastname: Rahal
authors.affiliation: Cardiology Department, CH Annecy, Annecy, France.
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.affiliation: Department of Cardiology, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Caussin
authors.affiliation: Department of Cardiology, Institut Mutualiste Montsouris, Paris, France. Electronic address: nicolas.amabile@imm.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Amabile
mesh_terms: D000367:Age Factors; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D012737:Sex Factors; D015607:Stents; D061665:Time-to-Treatment
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors