Deferred versus immediate stenting in patients with ST-segment elevation myocardial infarction: A systematic review and meta-analysis

Background-a number of studies have evaluated the efficacy of deferred stenting vs immediate stenting in patients with stsegment elevation myocardial infarction,but the findings were not consistent across these studies. this meta-analysis aims to assess optimal treatment strategies in patient with st-segment elevation myocardial infarction. methods and results-we searched the pubmed,embase,and the cochrane library for studies that assessed deferred vs immediate stenting in patients with st-segment elevation myocardial infarction. nine studies including 1456 patients in randomized controlled trials and 719 patients in observational studies were included in the meta-analysis. no significant differences were observed in the incidence of no- or slow-reflow between deferred stenting and immediate stenting in randomized controlled trials (odds ratio [or] 0.51,95%ci 0.17-1.53,p=0.23,i2=70%) but not in observational studies (or 0.13,95%ci 0.06- 0.31,p<0.0001,i2=0%). deferred stenting was associated with an increase in long-term left ventricular ejection fraction (weighted mean difference 1.90%,95%ci 0.77-3.03,p=0.001,i2=0%). no significant differences were observed in the rates of major adverse cardiovascular events (or 0.53,95%ci 0.27-1.01,p=0.06 [randomized or 0.98,95%ci 0.73-1.30,p=0.87,i2=0%; nonrandomized or 0.30,95%ci 0.15-0.58,p=0.0004,i2=0%]),major bleeding (or=0.1.61,95%ci 0.70-3.69,p=0.26,i2=0%),death (or=0.78,95% ci 0.53-1.15,p=0.22,i2=0%),mi (or=0.97,95%ci 0.34-2.78,p=0.96,i2=35%) and target vessel revascularization (or 0.97,95%ci 0.40-2.37,p=0.95,i2=24%),between deferred and immediate stenting. conclusions-compared with immediate stenting,a deferred-stenting strategy did not reduce the occurrence of no- or slowreflow,death,myocardial infarction,or repeat revascularization compared with immediate stenting in patients with st-segment elevation myocardial infarction,but showed an improved left ventricular function in the long term. © 2017 the authors.