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)

Je Sang Kim, Hyun Jong Lee, Cheol Woong Yu, Yang Min Kim, Soon Jun Hong, Jae Hyung Park, Rak Kyeong Choi, Young Jin Choi, Jin Sik Park, Tae Hoon Kim, Ho Jun Jang, Hyung Joon Joo, Sang A. Cho, Young Moo Ro, Do-Sun Lim

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background - 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. Methods and Results - 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. Conclusions - 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.

Original languageEnglish
JournalCirculation: Cardiovascular Interventions
Volume9
Issue number12
DOIs
Publication statusPublished - 2016 Dec 1

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Stents
Perfusion
Reperfusion
Incidence
Myocardial Infarction
Anterior Wall Myocardial Infarction
Intention to Treat Analysis
Percutaneous Coronary Intervention
Random Allocation
Dissection
Magnetic Resonance Imaging
Safety
ST Elevation Myocardial Infarction

Keywords

  • deferred stenting
  • infarct size microvascular obstruction
  • ST-segment-elevation myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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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). / Kim, Je Sang; Lee, Hyun Jong; Yu, Cheol Woong; Kim, Yang Min; Hong, Soon Jun; Park, Jae Hyung; Choi, Rak Kyeong; Choi, Young Jin; Park, Jin Sik; Kim, Tae Hoon; Jang, Ho Jun; Joo, Hyung Joon; Cho, Sang A.; Ro, Young Moo; Lim, Do-Sun.

In: Circulation: Cardiovascular Interventions, Vol. 9, No. 12, 01.12.2016.

Research output: Contribution to journalArticle

Kim, Je Sang ; Lee, Hyun Jong ; Yu, Cheol Woong ; Kim, Yang Min ; Hong, Soon Jun ; Park, Jae Hyung ; Choi, Rak Kyeong ; Choi, Young Jin ; Park, Jin Sik ; Kim, Tae Hoon ; Jang, Ho Jun ; Joo, Hyung Joon ; Cho, Sang A. ; Ro, Young Moo ; Lim, Do-Sun. / 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). In: Circulation: Cardiovascular Interventions. 2016 ; Vol. 9, No. 12.
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abstract = "Background - 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. Methods and Results - 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. Conclusions - 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.",
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AU - Kim, Je Sang

AU - Lee, Hyun Jong

AU - Yu, Cheol Woong

AU - Kim, Yang Min

AU - Hong, Soon Jun

AU - Park, Jae Hyung

AU - Choi, Rak Kyeong

AU - Choi, Young Jin

AU - Park, Jin Sik

AU - Kim, Tae Hoon

AU - Jang, Ho Jun

AU - Joo, Hyung Joon

AU - Cho, Sang A.

AU - Ro, Young Moo

AU - Lim, Do-Sun

PY - 2016/12/1

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N2 - Background - 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. Methods and Results - 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. Conclusions - 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.

AB - Background - 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. Methods and Results - 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. Conclusions - 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.

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