At least seven days delayed stenting using minimalist immediate mechanical intervention (MIMI) in ST-segment elevation myocardial infarction: the SUPER-MIMI study
Selected in EuroIntervention by S. Brugaletta
Mester P, Bouvaist H, Delarche N, Bouisset F, Abdellaoui M, Petiteau PY, Dubreuil O, Boueri Z, Chettibi M, Souteyrand G, Madiot H, Belle L
EuroIntervention. 2017 Jul 20;13(4):390-396
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What is known
Although primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in acute STEMI, up to two thirds of STEMI patients treated by primary PCI have suboptimal myocardial reperfusion, which can be secondary to microvascular embolization. The present study soughs to explore the safety of a minimalist immediate mechanical reperfusion (MIMI) followed by a second PCI with the intention of culprit-lesion stenting after 7 days in STEMI patients with a large thrombotic load.
- This was a prospective, observational trial.
- A total of 155 patients were enrolled.
- The pharmacological therapy was left to the operator’s discretion. Eighty-one patients (52.3%) had glycoprotein IIb/IIIa inhibitors (GPI) initiated before the end of the first procedure.
- The median (interquartile range [IQR]) delay between the two procedures was eight (seven to 12) days.
- Infarct-related artery re-occlusion between the two procedures (primary endpoint) occurred in two patients (1.3%), neither of whom received GPI treatment.
- TIMI flow was maintained or improved between the end of the first procedure and the beginning of the second procedure in all patients.
- Thrombotic burden and stenosis severity diminished significantly between the two procedures. Stents were ultimately implanted in 97 patients (62.6%).
Sometimes in our daily clinical practice we face STEMI with large thrombotic burden without an apparent stenotic lesion to be stented. There are many case reports in the literature, describing the feasibility of a delayed stenting of such lesions after days of a primary PCI, whose aim is only to reopen the artery without any stent implanted. This study represents the first systematic evaluation of this approach, called minimally invasive, which consists in reestablishing coronary flow during the acute episode, administrating anti-thrombotic agents and re-evaluating the culprit vessel after some days in order to decide to stent or not. Despite few patients enrolled, it represents an important hypothesis generating study, which hopefully will be tested in a future and large trial.