Abstract 4363871: Immediate versus Deferred Stenting in Acute Myocardial Infarction: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: The timing of stent placement in acute myocardial infarction (AMI) remains a subject of clinical debate. Immediate stenting is widely practiced, while deferred stenting has been proposed to minimize complications such as distal embolization and no-reflow. This meta-analysis compares the clinical, procedural, and safety outcomes of immediate versus deferred stenting in AMI patients. Research Question: Does deferred stenting offer a similar safety profile as immediate stenting? Methods: This study was conducted in accordance with PRISMA 2020 guidelines. A systematic search of PubMed, Embase, HINARI, and ClinicalTrials.gov identified randomized controlled trials (RCTs) published between 2010 and 2024, comparing immediate and deferred stenting in adult AMI patients. Data extraction and bias assessment (ROB-2.0) were performed independently by two reviewers. Statistical analysis used fixed- and random-effects models, reporting odds ratios (ORs) with 95% confidence intervals (CIs) Results: Nine RCTs comprising 4,161 patients (2,070 immediate; 2,091 deferred) were included. There were no significant differences between immediate and deferred stenting in terms of all-cause mortality (OR: 1.29 [0.88–1.90], p =0.19), cardiac death (OR: 1.34 [0.73–2.45], p =0.34), non-fatal myocardial infarction (OR: 1.11 [0.76–1.63], p =0.59), or heart failure hospitalization (OR: 1.21 [0.73–2.01], p =0.47). Procedural complications such as micro vascular obstruction (OR: 1.18 [0.84–1.65], p =0.34), distal embolization (OR: 2.43 [0.12–48.20], p =0.56), and TIMI major bleeding (OR: 0.54 [0.22–1.36], p =0.19) were similar. No significant differences were found in ST-segment resolution (OR: 0.69 [0.40–1.19], p =0.18) or left ventricular ejection fraction (OR: 1.01 [0.78–1.32], p =0.92). Immediate stenting showed fewer unplanned target vessel revascularizations (OR: 0.60 [0.36–1.00], p =0.05) and a higher likelihood of calcium channel blocker use at discharge (OR: 1.44 [1.12–1.87], p =0.005). Conclusions: Immediate and deferred stenting in patients with acute myocardial infarction (AMI) demonstrate comparable efficacy and safety across major clinical and procedural outcomes. While immediate stenting may reduce the need for repeat interventions, current evidence does not strongly favor one strategy over the other. The safety profiles of both approaches are similar, with no significant advantage observed for either technique.