Randomized trial of deferred stenting with apixaban in high thrombus burden stemi using 3d echocardiography
I Shehata, M E Soliman, H S Roshdy, M I AlAwadiAbstract
Background
In STEMI with high thrombus burden, immediate stenting increases distal embolization, potentially impairing myocardial recovery. Deferred stenting might improve outcomes, but the optimal adjunctive therapy remains uncertain.
Purpose
To evaluate the effects of deferred stenting with dual antiplatelet therapy (DAPT) and triple therapy (including Apixaban) on myocardial recovery and microvascular perfusion in high thrombus burden STEMI.
Methods
In this randomized trial, 150 STEMI patients with high thrombus burden were assigned to three groups: immediate stenting, deferred stenting with DAPT, or deferred stenting with triple therapy including Apixaban. The primary endpoints were TIMI flow and myocardial blush grade (MBG) at 6 months. Secondary endpoints included major adverse cardiovascular events (MACE), reinfarction, stroke, mortality, and left ventricular ejection fraction (LVEF) assessed by 3D speckle-tracking echocardiography.
Results
Deferred stenting with Apixaban led to superior angiographic and functional outcomes. TIMI III flow was achieved in 94% of patients in the Apixaban group compared to 76% in the DAPT group (p=0.03). MBG 3 was observed in 82.9% of patients in the Apixaban group, compared to 70.9% in DAPT and 30% in the immediate stenting group (p<0.01). Apixaban significantly reduced no-reflow (p<0.01) and improved LVEF (+14.5% vs. +12.9%, p=0.0067). No significant differences were noted in MACE and mortality at 6 months (p=0.45 and p=0.52, respectively).
Conclusion
Deferred stenting with triple therapy, including Apixaban, improves myocardial recovery and microvascular perfusion in high thrombus burden STEMI without reducing short-term MACE. Larger studies are needed to assess long-term survival and benefits.Figure 1-3D measurements of LV volumes and EFFor image description, please refer to the figure legend and surrounding text.Figure 2-6 months FU of 3D LV volumes and EFFor image description, please refer to the figure legend and surrounding text.