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Stent delay may help heart patients

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The recovery of patients who have suffered the most serious type of heart attack could be improved by delaying a routine procedure, according to new research.

A study by Professor Colin Berry and colleagues at the University of Glasgow and the Golden Jubilee National Hospital has found that it can be beneficial to defer one particular treatment in certain cases of heart attacks known as a ST segment elevation myocardial infarction (STEMI).

A STEMI happens when the coronary artery is completely blocked which causes a prolonged interruption of the blood supply if not treated quickly.

Normally, people who have had a ‘high risk’ STEMI heart attack would have a stent inserted immediately to reopen the blocked artery if they were at risk of ‘no reflow’.

About 40% of STEMI patients are at risk of ‘no reflow’ which is when blood does not return to an oxygen-starved area of the heart due to tiny vessels within the damaged muscle preventing blood flow.

The study, funded by the British Heart Foundation (BHF) and the Chief Scientist Office of NHS Scotland, involved 101 patients who had suffered a STEMI heart attack and were at high risk of ‘no reflow’. One group had the stent inserted immediately while the other had the procedure delayed by up to 16 hours.

Results of this trial, presented to the American College of Cardiology (ACC) conference on Saturday, March 9, suggest that waiting before inserting a stent reduces the likelihood of ‘no-reflow’ in STEMI patients who were a high-risk.

Prof Berry, of the Institute of Cardiovascular and Medical Sciences and Honorary Consultant Cardiologist at the Golden Jubilee National Hospital, said: “Deferred stenting means there is a period of time where a healing process of sorts can take place. Because a stent is placed around an area where there has been a clot, if it is placed immediately some clot material can be dislodged which then cause a blockage in small blood vessels. When the stent placement is deferred, it is placed in better circumstances.”

The conclusions of this trial show a potential for deferred stenting to improve safety and cost-effectiveness in patient care according to Prof Berry who said there was a need for further research across a wider sample area.

Professor Jeremy Pearson, Associate Medical Director at the BHF, said: “This is an interesting result suggesting that the outcome may be better for one group of patients who have had a major heart attack caused by a fully blocked artery if stenting is delayed. However, bigger trials with a lengthier follow-up of patients would be needed before there’s a change in clinical practice.”

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