However, these subgroup analysis results do not have sufficient statistical power to conclude deferred stenting is beneficial in the left anterior wall myocardial infarction, it is important to reaffirm the results with a large randomized control trial exclusively selected for left anterior wall myocardial infarction. These findings suggest that the left anterior descending artery has more microvascular bed than the other vessels, and thus the positive result of deferred stenting could be maximized. According to the subgroup analysis of the INNOVATION study, in the cases of anterior wall myocardial infarction, deferred stenting strategy reduced not only the infarction size but also the incidence of microvascular obstruction. additional rationale is what is called the "vascular cooling down" to avoid mechanical stimulus in the milieu of active inflammation within an infarct-related artery in the early stages of myocardial infarction and prolong exposure to intensive statin therapy before stent implantation.īased on this theory, four randomized control trials were published recently, but their results were different. The theoretical basis for the hypothesis is that prolonged antiplatelet therapy and anticoagulation for a deferral period may enable the resolution of the thrombus burden in infarct-related arteries, which is a substrate of distal embolization and subsequent microvascular obstruction. Recently, the theory that deferred stenting can reduce microvascular obstruction has been suggested. To date, two treatment strategies have been proven to be effective in the treatment of distal microvascular embolism, which are manual thrombus aspiration and intracoronary administration of abciximab. It is also well known that the phenomenon increases the incidence of re-infarction and the size of myocardial infarction and induces left ventricular remodeling after several months. A "no-reflow" phenomenon or microvascular obstruction, a serious form of microvascular dysfunction, raises the late mortality rate of patients who underwent reperfusion from 1.9 to 7.1 times. However, many of these patients had microvascular dysfunction assessed by myocardial brush and ST segment complete response, and only about 35% of these patients achieved ideal reperfusion in which blood flow was smoothly delivered to the myocardium and tissue. Infarction-associated epicardial coronary arteries reach Thrombolysis In Myocardial Infarction (TIMI) 3 blood flow in approximately 90% of patients after primary coronary intervention. Study background The main treatment for acute ST segment elevation myocardial infarction due to thrombogenesis and complete occlusion resulting from rupture or erosion of the atherosclerotic plaque in the coronary artery is to rapid open of the coronary artery through the coronary intervention. Procedure: Immediate stenting Procedure: Deferred stenting Stent malappositionĪcute Myocardial Infarction With ST Elevation Anterior Wall Myocardial Infarction Minimal scaffold area and area stenosis iv. Microvascular obstruction (MVO) size iii. Primary Endpoint) Composite of all-cause death, hospitalization due to heart failure, recurrent myocardial infarction (MI), target vessel revascularization (TVR) at 2 years. Investigator or designee may conduct follow-up as telephone contacts or office visits. Patient Follow-Up) Clinical follow-up will occur at 1, 6, 12 months, 2, 3 years and 5 years. Patient Enrollment) 460 patients will be enrolled at 20 centers in South-Korea Study Design) A multicenter, prospective, randomized, controlled, open-label clinical trial for anterior wall STEMI patients the intravascular findings using optical coherence tomography (OCT).the structural and functional cardiac remodeling using conventional echocardiography and strain imaging.the microvascular obstruction using Cardiac magnetic resonance (MR).Objectives) To evaluate the impact of deferred versus immediate stenting in patients with acute ST-segment elevation anterior wall myocardial infarction (STEMI) on Trial Name) Impact of Immediate SteNt ImplaNtatiOn Versus Deferred Stent ImplAntaTION on Clinical Outcomes in Patients with AnteRior Wall ST-segment Elevation Myocardial Infarction (INNOVATION-CORE) Why Should I Register and Submit Results?.
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