ST-segment Elevation Myocardial Infarction (STEMI) Clinical Trial
Official title:
A Randomized Multicentre Trial to Compare Early With Deferred Invasive Strategy for Patients With Acute ST-segment Elevation Myocardial Infarction Presenting 24-48 Hours From Symptom Onset
The primary objective of the trial is to compare the efficacy of early with deferred invasive strategy for patients with ST-segment elevation myocardial infarction (STEMI) within 24-48h of symptom onset.
At present, timely primary percutaneous coronary intervention (PCI) is the preferred strategy
for STEMI patients within 24h of symptom onset. In stable STEMI patients presenting 12 to 48
hours from symptom onset, BRAVE-2 Trial (n = 365) showed improved myocardial salvage and
4-year survival in patients treated with primary PCI compared with conservative treatment
alone. However, data is scarce about the reperfusion strategy focusing on STEMI patients
within 24-48h of symptom onset.
To our knowledge, due to the long onset time and insufficient antiplatelet/anticoagulant
treatment, infarct-related artery in STEMI patients beyond 24h of symptom onset frequently
suffer from severer thrombus burden. In this situation, the risk of no-reflow in primary PCI
is high. Meanwhile, myocardial coagulative necrosis would be fully developed during 24-72h
from symptom onset, the risk of perioperative cardiac rupture may also rise. These bring some
doubts about the benefits of early invasive strategy for STEMI patients within 24-48h of
symptom onset. Further investigations are warranted to explore the best timing of invasive
strategy for STEMI patients within 24-48h of symptom onset.
Given that no randomized clinical trial is designed especially for STEMI patients within
24-48h of symptom onset, and limited data is available to compare early with deferred
invasive strategy for the subgroup of STEMI patients, investigators plan to perform a
controlled, randomized trial to compare the efficacy of early with deferred invasive strategy
for STEMI patients within 24-48h of symptom onset.
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