Deferred versus Immediate Stenting in Patients Presenting with Aborted Myocardial Infarction: An Observational Study

Abdelbasit, Mohamed Salah; Salama, Mohamed Hosainy; El-Shetry, Mohamed Saad

doi:10.21608/zumj.2025.376947.3917

Deferred versus Immediate Stenting in Patients Presenting with Aborted Myocardial Infarction: An Observational Study

Document Type : Original Article

Authors

¹ Cardiology department, Faculty of Medicine, Zagazig university, Egypt

² Intern at Zagazig University Hospitals, Egypt

³ Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

10.21608/zumj.2025.376947.3917

Abstract

Background: No-reflow is challenging during primary percutaneous coronary intervention (PCI) of acute myocardial infarction (MI) patients. In stable patients with spontaneously aborted MI, no-reflow could worsen the patients’ outcomes. Deferring stenting in such patients could decrease the risk of no-reflow and improve outcomes.

Methods: This prospective cohort study included all patients with aborted MI defined as complete resolution of chest pain and ST segment elevation, and TIMI 3 flow on the initial angiography of the culprit vessel, presenting within 48 hours of chest pain onset. We compared patients who underwent immediate stenting with those with deferred PCI after 48 hours of glycoprotein IIb/IIIa inhibitors infusion regarding risk of no-reflow, in-hospital and one-year outcomes.

Results: This study involved 316 patients with aborted myocardial infarction. Deferred PCI (106 patients) had a lower incidence of no-reflow (20.8% vs 37.1%; P = 0.003), in-hospital heart failure (17% vs 31%; P = 0.007), and one-year all-cause mortality (2.8% vs 9%; P = 0.04) without increase in bleeding risk or in-hospital re-infarction. Regression analysis revealed that lesion length was the most independent predictor of no-reflow (OR: 1.120; P <0.001). BNLTI (Bifurcation culprit lesion, Number of stent inflations, lesion Length, Thrombus, and Immediate PCI) factor is a novel parameter with cut-off value ≥0.389 predicts no-reflow in patients with aborted MI with sensitivity 80% and specificity 77.3% (AUC: 0.838; P <0.001).

Conclusion: Deferred stenting in patients presenting with aborted MI is associated with lower incidence of no-reflow, better in-hospital and one-year outcomes without increased risk of re-infarction.

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