title: INNOVATION Study (Impact of Immediate Stent Implantation Versus Deferred Stent Implantation on Infarct Size and Microvascular Perfusion in Patients With ST-Segment-Elevation Myocardial Infarction).
abstract: The aim of this study was to assess whether deferred stenting (DS) reduces infarct size and microvascular obstruction (MVO) compared with immediate stenting (IS) in primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction.
  
  
  
  From February 2013 to August 2015, 114 patients (mean age: 69 years) were randomized into the following 2 groups: DS with an intention to stent 3 to 7 days later or IS after primary reperfusion in 2 centers. The primary and secondary end points were infarct size and the incidence of MVO, respectively, assessed by cardiac magnetic resonance imaging at 30 days after primary reperfusion. The median time to the second procedure in the DS was 72.8 hours. Six patients in the DS group were crossed over to the IS group because of progression of dissection or safety concerns after randomization. In the intention-to-treat analysis, DS did not significantly reduce infarct size (15.0% versus 19.4%; P=0.112) and the incidence of MVO (42.6% versus 57.4%; P=0.196), compared with IS. However, in anterior wall myocardial infarction, infarct size (16.1% versus 22.7%; P=0.017) and the incidence of MVO (43.8% versus 70.3%; P=0.047) were significantly reduced in the DS group. There was no urgent revascularization event during deferral period.
  
  
  
  A routine DS did not significantly reduce infarct size and MVO compared with IS, although it was safe. The beneficial effect of DS in patients with anterior myocardial infarction should be confirmed by larger randomized studies.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02324348.
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Je Sang
authors.initials: JS
authors.lastname: Kim
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.). ycw717@naver.com.
authors.forename: Cheol
authors.initials: C
authors.lastname: Woong Yu
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Yang Min
authors.initials: YM
authors.lastname: Kim
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Soon Jun
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Park
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Rak Kyeong
authors.initials: RK
authors.lastname: Choi
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Jin Sik
authors.initials: JS
authors.lastname: Park
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Kim
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Ho-Jun
authors.initials: HJ
authors.lastname: Jang
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Joo
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Sang-A
authors.initials: SA
authors.lastname: Cho
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Young Moo
authors.initials: YM
authors.lastname: Ro
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
authors.forename: Do-Sun
authors.initials: DS
authors.lastname: Lim
mesh_terms: D000368:Aged; D056988:Anterior Wall Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D054318:No-Reflow Phenomenon / Q000209:etiology / Q000503:physiopathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011446:Prospective Studies; D056910:Republic of Korea; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: ST-segment–elevation myocardial infarction; deferred stenting; infarct size microvascular obstruction