Université d'Auvergne Clermont1 | CNRS

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Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment-Elevation Myocardial Infarction: The MIMI Study.

TitleComparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment-Elevation Myocardial Infarction: The MIMI Study.
Publication TypeJournal Article
Year of Publication2016
AuthorsBelle, L., P. Motreff, L. Mangin, G. Rangé, X. Marcaggi, A. Marie, N. Ferrier, O. Dubreuil, G. Zemour, G. Souteyrand, C. Caussin, N. Amabile, K. Isaaz, R. Dauphin, R. Koning, C. Robin, B. Faurie, L. Bonello, S. Champin, C. Delhaye, F. Cuilleret, N. Mewton, C. Genty, M. Viallon, J. L. Bosson, and P. Croisille
Corporate AuthorsMIMI Investigators*
JournalCirculation. Cardiovascular interventions
Volume9
Issue3
Paginatione003388
Date Published2016 Mar
ISSN1941-7632
Abstract

BACKGROUND: Delayed stent implantation after restoration of normal epicardial flow by a minimalist immediate mechanical intervention aims to decrease the rate of distal embolization and impaired myocardial reperfusion after percutaneous coronary intervention. We sought to confirm whether a delayed stenting (DS) approach (24-48 hours) improves myocardial reperfusion, versus immediate stenting, in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

METHODS AND RESULTS: In the prospective, randomized, open-label minimalist immediate mechanical intervention (MIMI) trial, patients (n=140) with ST-segment-elevation myocardial infarction ≤12 hours were randomized to immediate stenting (n=73) or DS (n=67) after Thrombolysis In Myocardial Infarction 3 flow restoration by thrombus aspiration. Patients in the DS group underwent a second coronary arteriography for stent implantation a median of 36 hours (interquartile range 29-46) after randomization. The primary end point was microvascular obstruction (% left ventricular mass) on cardiac magnetic resonance imaging performed 5 days (interquartile range 4-6) after the first procedure. There was a nonsignificant trend toward lower microvascular obstruction in the immediate stenting group compared with DS group (1.88% versus 3.96%; P=0.051), which became significant after adjustment for the area at risk (P=0.049). Median infarct weight, left ventricular ejection fraction, and infarct size did not differ between groups. No difference in 6-month outcomes was apparent for the rate of major cardiovascular and cerebral events.

CONCLUSIONS: The present findings do not support a strategy of DS versus immediate stenting in patients with ST-segment-elevation infarction undergoing primary percutaneous coronary intervention and even suggested a deleterious effect of DS on microvascular obstruction size.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01360242.

DOI10.1161/CIRCINTERVENTIONS.115.003388
Alternate JournalCirc Cardiovasc Interv