, Volume 44, Issue 8, pp 726–734 | Cite as

Delayed vs. immediate stenting in STEMI with a high thrombus burden

A systematic review and meta-analysis
  • B. Sun
  • J. Liu
  • H. Yin
  • S. Yang
  • Z. Liu
  • T. Chen
  • J. Li
  • C. Guo
  • Z. JiangEmail author
Original articles



The results of several large-scale randomized controlled trials are controversial regarding the advantages of delayed stenting (DS) compared with immediate stenting (IS). We sought to determine whether DS has benefits for patients with ST-segment elevation myocardial infarction (STEMI) with a high thrombus burden compared with IS.


We systematically searched four electronic databases. Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow, TIMI myocardial blush grade (TMBG), complete ST-segment resolution (>70%), major adverse cardiac events (MACE), and major bleeding complications were studied as outcomes. Data analysis was performed using a random-effects model utilizing the Review Manager 5.3 software.


Our meta-analysis included eight studies involving 744 patients. DS showed greater benefits than IS in terms of TIMI grade 3 flow (odds ratio [OR]: 5.09, 95% confidence interval [CI]: 1.98–13.02, p < 0.001), TMBG (OR: 4.17, 95% CI: 1.87–9.31, p < 0.001), complete ST-segment resolution (OR: 2.16, 95% CI: 1.36–3.43, p = 0.001), and MACE (OR: 0.48, 95% CI: 0.25–0.94, p = 0.03). No significant difference was observed regarding major bleeding events (OR: 1.76, 95% CI: 0.40–7.66, p = 0.45).


DS yielded satisfactory outcomes regarding myocardial tissue reperfusion, demonstrated by the improved TIMI flow grade, TMBG, complete ST-segment resolution, and decreased MACEs without increasing major bleeding events in patients with STEMI and a high thrombus burden. DS may be preferred to IS for treating patients with this characteristic presentation.


Stents Thrombosis ST-segment elevation myocardial infarction No-reflow phenomenon Randomized controlled trials 



Confidence interval


Delayed stenting


Glycoprotein IIb/IIIa inhibitors


Infarct-related artery


Immediate stenting


Major adverse cardiac event


Myocardial infarction


Microvascular obstruction


Odds ratio


Percutaneous coronary intervention


Randomized controlled trial


ST-segment elevation myocardial infarction


Thrombolysis in Myocardial Infarction


TIMI myocardial blush grade

Verzögerte vs. unmittelbare Stentimplantation bei STEMI mit hoher Thrombuslast

Systematische Übersicht und Metaanalyse



Die Ergebnisse verschiedener großangelegter randomisierter kontrollierter Studien sind widersprüchlich hinsichtlich der Vorteile verzögerter Stenteinlage („delayed stenting“, DS) verglichen mit unmittelbarer Stenteinlage („immediate stenting“, IS). Ziel der Autoren war, zu untersuchen, ob die DS Vorteile für Patienten mit ST-Strecken-Hebungs-Infarkt („ST-segment elevation myocardial infarction“, STEMI) mit einer hohen Thrombuslast im Vergleich zur IS aufweist.


Die Autoren durchsuchten 4 elektronische Datenbanken systematisch. Als Endpunkte wurden ein Fluss des Grades 3 gemäß Thrombolysis in Myocardial Infarction (TIMI), der Myokardperfusionsgrad gemäß TIMI („TIMI myocardial blush grade“, TMBG), die vollständige Rückbildung der ST-Stecken-Hebung (>70%), schwere unerwünschte kardiale Ereignisse („major adverse cardiac events“, MACE) und schwere Blutungskomplikationen untersucht. Die Datenanalysis erfolgte unter Verwendung eines Random-Effects-Modells mit der Software Review Manager 5.3.


Die vorliegende Metaanalyse umfasste 8 Studien mit 744 Patienten. Eine DS erbrachte größere Vorteile als eine IS in Bezug auf einen Fluss des Grades 3 gemäß TIMI (Odds Ratio, OR: 5,09; 95%-Konfidenzintervall, 95%-KI: 1,98–13,02; p < 0,001), TMBG (OR: 4,17; 95%-KI: 1,87–9,31; p < 0,001), vollständige Rückbildung der ST-Strecken-Hebung (OR: 2,16; 95%-KI: 1,36–3,43; p = 0,001) und MACE (OR: 0,48; 95%-KI: 0,25–0,94; p = 0,03). Es fand sich kein signifikanter Unterschied hinsichtlich schwererer Blutungen (OR: 1,76; 95%-KI: 0,40–7,66; p = 0,45).


Die DS führte zu zufriedenstellenden Ergebnissen in Bezug auf die Reperfusion des Myokards; dies zeigte sich durch eine Verbesserung beim TIMI-Flussgrad, TMBG, bei der vollständigen Rückbildung der ST-Strecken-Hebung und weniger MACE ohne zunehmende schwerere Blutungen bei Patienten mit STEMI und einer hohen Thrombuslast. Die DS ist möglicherweise gegenüber der IS bei der Behandlung von Patienten mit solchen typischen Symptomen zu bevorzugen.


Stents Thrombose ST-Strecken-Hebungs-Infarkt No-Reflow-Phänomen Randomisierte kontrollierte Studien 



We thank all patients who participated in the original studies and the authors providing the relevant data.

Compliance with ethical guidelines

Conflict of interest

B. Sun, J. Liu, H. Yin, S. Yang, Z. Liu, T. Chen, J. Li, C. Guo, and Z. Jiang declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of CardiologyThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
  2. 2.Department of Occupational and Environmental Health, Xiangya School of Public HealthCentral South UniversityChangshaChina
  3. 3.Center for Disease Control and Prevention of Hebei Province; NO.97 Huaian RoadDepartment of Epidemiology and Health StatisticsShijiazhuangChina

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