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

Loic Belle (1) , Pascal Motreff (2) , Lionel Mangin , Grégoire Range (3) , Xavier Marcaggi (4) , Marie Antoine , Nadine Ferrier (4) , Olivier Dubreuil (5) , Gilles Zemour (6) , Geraud Souteyrand (7) , Christophe Caussin (8) , Nicolas Amabile (9) , Karl Isaaz (9) , Raphaël Dauphin (10) , René Koning (11) , Christophe Robin (12) , Benjamin Faurie (13) , Laurent Bonello (14) , Stanislas Champin (15) , Cédric Delhaye (16) , François Cuilleret (17) , Nathan Mewton (18) , Céline Genty (19) , Magalie Viallon (9, 20) , Jean Luc Bosson (19) , Pierre Croisille (9, 20) , . Mimi Investigators

1 Centre Hospitalier Annecy-Genevois, 74000-Annecy, France
2 CHU Gabriel Montpied [Clermont-Ferrand]
3 HOPITAL CHARTRES - DEPT CARDIOL
4 Ctr Hosp Vichy
5 CTR HOSP ST LUC ST JOSEPH - DEPT CARDIOL
6 Centre Hospitalier de Cannes - Centre Hospitalier de Cannes
7 CHU Clermont-Ferrand
8 IMM - Institut Mutualiste de Montsouris
9 Hôpital nord, St Etienne
10 Service de Cardiologie de l'hopital de la Croix Rousse
11 Service de Cardiologie, Rouen - Clinique St Hilaire
12 CLINIQUE CONVERT - CEPT CARDIOL
13 CRT HOSP MUTUALISTE - CARDIO INST
14 VRCM - Vascular research center of Marseille
15 CH DE VALENCE - Centre Hospitalier de Valence
16 CHRU Lille - Centre Hospitalier Régional Universitaire [Lille]
17 Centre hospitalier Les Chanaux [Mâcon]
18 Hôpital Louis Pradel - Services de Pneumologie, Exploration Fonctionnelle Respiratoire et Cardiologie
19 CHU - Centre Hospitalier Universitaire [Grenoble]
20 RMN et optique : De la mesure au biomarqueur

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.

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.

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.

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01360242.

Keywords: myocardial infarction; infarction; ST-segment–elevation myocardial infarction; MICROVASCULAR OBSTRUCTION; CARDIAC MAGNETIC-RESONANCE; THROMBUS ASPIRATION; RANDOMIZED-TRIAL; NO-REFLOW; IMPLANTATION; MANAGEMENT; THROMBECTOMY; METAANALYSIS; PERCUTANEOUS CORONARY INTERVENTION; stent

Domains: Life Sciences [q-bio]

Loic Belle, Pascal Motreff, Lionel Mangin, Grégoire Range, Xavier Marcaggi, et al.. Comparison of Immediate With Delayed Stenting Using the Minimalist Immediate Mechanical Intervention Approach in Acute ST-Segment-Elevation Myocardial Infarction: The MIMI Study.. Circulation: Cardiovascular Interventions, 2016, 9, pp.e003388. ⟨hal-01457797⟩