Index of Microcirculatory Resistance After Immediate Versus Deferred Stenting in Patients With Acute Myocardial Infarction

Study Overview
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Brief Summary
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This study will compare the microcirculatory resistance (IMR) of infarct-related artery (IRA) in patients who underwent immediate versus deferred stenting during percutaneous coronary intervention (PCI) for acute myocardial infarction.

Detailed Description
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Primary PCI with immediate stenting (IS) is the current standard of reperfusion strategy for STEMI. However, it is thought that IS may cause additional myocardial injury by increasing distal embolization of clot and atheromatous plaque debris. Only about 35% of patients without cardiogenic shock can achieve optimal myocardial tissue perfusion at the microvascular level, even after restoration of epicardial coronary artery patency. IS in highly pro-thrombotic and inflammatory milieu of IRA during primary PCI would increase distal embolization of clot and atheromatous plaque debris, and provoke the inflammation process, so deferred stenting after a cooling down period of IRA for several days, have a potential to mitigate or prevent microvascular obstruction (MVO). Among several methods to evaluate MVO after STEMI, IMR has been well known as an good indicator of MVO and strong predictor for short and long term clinical outcomes.

Official Title
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Index of Microcirculatory Resistance After Immediate Versus Deferred Stenting in Patients With Acute Myocardial Infarction

Conditions
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Acute Myocardial Infarction

Intervention / Treatment
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* Procedure: Deferred stenting


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: More than 30 minutes in duration of typical chest pain Thrombolysis In Myocardial Infarction (TIMI) flow 0, 1 or 2 prior to the procedure Exclusion Criteria: Cardiogenic shock, Previous history of myocardial infarction, or coronary artery bypass surgery Rescue PCI after fibrinolysis Life expectancy of less than 1 year Acute occlusion of left main coronary artery STEMI due to stent thrombosis Major coronary dissection (type D F) following procedures achieving TIMI 3 flow

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Immediate stenting group<br>Conventional stenting immediate after the re-opening of infarct-related artery during primary PCI | |
| Deferred stenting group<br>Elective stenting following cooling down of infarct- related artery for several days after restoration of epicardial coronary blood flow during primary PCI | Procedure: Deferred stenting<br>* Previously described<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Index of microcirculatory resistance of infarct-related artery | Measured by pressure and temperature sensors- tipped guide wire | 3 to 5 days after primary reperfusion (TIMI 3 flow achievement) in both groups | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The rate of urgent revascularization |  | During index hospitalization (intraoperative) | 
| Major bleeding | Defined as TIMI bleeding criteria | During index hospitalization (intraoperative) | 
| Major adverse cardiac events | Death, myocardial infarction, unplanned target vessel revascularization or CHF admission | One- year after primary reperfusion | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Deferred stenting, Microvascular dysfunction