Original Title: Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment–Elevation Myocardial Infarction. The MIMI Study. Reference: Loic Belle et al. Circ Cardiovasc Interv. 2016 Mar;9(3).
Delayed stenting after normal epicardial flow restoration is meant to lower the chance of distal embolization and to improve reperfusion in the context of primary PCI.
This study was designed to compare the minimalist technique of delayed stenting (a las 24-48 hs) vs. immediate stenting in patients undergoing ST elevation MI, receiving primary PCI.
It included 140 patients undergoing ≤12 hr. evolution STEMI randomized to immediate stenting (n=73) vs delayed stenting (n=67) after TIMI flow III restoration by thromboaspiration.
Patients in the delayed stenting group had a second stenting procedure at mean 36 hrs. after randomization (range 29-46 hrs.).
Primary end point was micro vascular obstruction by MRI at 5 days after the first procedure.
A minor tendency to less micro vascular obstruction in the immediate stent group was observed, compared to the delayed stent group (1.88% vs 3.96%; p=0.051); this difference became significant after adjusting for area at risk (p=0.049).
Mean infarction size and ejection fraction resulted similar between the groups.
There were no differences in cardiovascular events after 6 months.
Conclusion
The result of this study does not support the delayed stenting strategy in patients undergoing primary PCI and even suggests it could be detrimental.