DEFERRED STENTING STRATEGY IN ACUTE STEMI WITH HIGH THROMBUS BURDEN: CLINICAL AND ANGIOGRAPHIC OUTCOMES

Abstract

Background: In ST-elevation myocardial infarction (STEMI) with high thrombus burden, immediate stenting may increase distal embolization, no-reflow, and acute stent thrombosis. Deferred stenting has been proposed as a selective alternative strategy.We evaluated the feasibility, safety, and short-term outcomes of deferred stenting in patients presenting with STEMI and large angiographic thrombus burden. Methods: We conducted a prospective, single-centre observational case series including consecutive STEMI patients managed within 48 h of symptom onset and presenting with thrombus grade ≥4 or TIMI flow ≤2. Initial management consisted of gentle mechanical reperfusion without stent implantation, combined with dual antiplatelet therapy, unfractionated heparin, and tirofiban infusion. A planned second angiography was performed between 48 h and 7 days; stenting was undertaken only when significant residual stenosis persisted. Outcomes included thrombus regression, final TIMI flow, in-hospital events, and short-term clinical and echocardiographic evolution.