Deferred Versus Immediate Stenting for Treatment of Acute Myocardial Infarction: a Retrospective Matched Evaluation

Background: In myocardial infarction, despite successful treatment by primary percutaneous coronary intervention with stent implantation, unsuccessful reperfusion may occur. The aim of this study was to assess clinical outcomes of a deferred stenting strategy and to determine criteria benefitting most of this strategy. Methods: This mono-centric retrospective study included all patients managed by deferred stenting for AMI between 2014 and 2020 (n = 80). This group was matched in 2:1 with patients treated by immediate stenting (n = 160). The primary endpoint was a composite of major adverse cardiac event at 1 and 2 years follow up. Secondary endpoints included angiographic and clinical parameters. Further patients were stratified according to conditions retained favorable to a deferred stenting strategy. Results: The primary endpoint occurred in 26 (16%) patients in the IS group and in 21 (26%) in the DS group at 2 years follow-up. (OR 0.55 [0.28 – 1.05]; P = 0.07). No significant differences were found in intra-hospital outcome as well as LVEF at a median follow up of 36 months. A significant difference was observed in the subgroup of patients with lack of collaterals and with short ischemia time, favoring immediate stenting (6 [37.5%] vs 2 [6.2%] ; OR 0.11; P = 0.01). Conclusion: In patients with AMI differate stent implantation does not reduce occurrence of MACE compared with conventional strategy up to 2 years follow-up. Stratified analysis suggests that deferred stenting should be avoided in absence of collaterals combined with an early AMI presentation.