Impact of Immediate SteNt ImplaNtatiOn Versus Deferred Stent ImplAntaTION on Clinical Outcomes in Patients with AnteRior Wall ST-segment Elevation Myocardial Infarction (INNOVATION-CORE)

초록

BACKGROUND Deferred stenting in ST-segment elevation myocardial infarction (STEMI) has been proposed to reduce distal embolization and improve outcomes, but previous studies have shown inconsistent results. This study aimed to evaluate whether deferred stenting improves clinical outcomes compared to immediate stenting in anterior STEMI. METHODS This was a multicenter, prospective, randomized, open-label trial conducted at 10 institutions between April 2018 and April 2023. Eligible patients were aged ≥19 years, presented within 6 hours of symptom onset, and had culprit lesions in the ostial to mid-left anterior descending artery. After achieving optimal coronary flow, patients were randomized to immediate or deferred stenting (planned 3 to 7 days later). The primary composite endpoint included all-cause death, hospitalization for heart failure, recurrent myocardial infarction, and target vessel revascularization. Secondary outcomes included each component of the primary endpoint and cardiac mortality. RESULTS A total of 181 patients were randomized (91 immediate, 90 deferred). The trial was terminated early due to slow enrollment. Sixteen patients in the deferred group underwent immediate stenting due to impaired flow. Median follow-up was 730 days. The primary endpoint occurred in 7.8% (deferred) and 8.8% (immediate) (hazard ratio 0.85, 95% CI 0.31–2.35; p=0.75). No significant differences were observed in secondary outcomes. CONCLUSION In anterior STEMI, deferred stenting did not significantly improve clinical outcomes compared to immediate stenting. Further large-scale studies are needed.