The Canadian Journal of Cardiology has published a paper on the timing of coronary stenting, a thought-provoking paper that challenges one of the dogmas of acute heart attack management today.
Emergency procedures to open blocked coronary arteries in patients with acute myocardial infarction have revolutionized cardiology by preventing heart attacks and their complications. Stents (types of springs) are usually put into these arteries to keep them open after they have been unblocked by "clot-busting". The research presented in this paper provides data suggesting an alternative approach, one in which stents are not inserted immediately but several days after the intervention when the artery has had time to heal, may be superior. This idea counters much of present thinking.
In the editorial of the same issue, "From Primary to Secondary Percutaneous Coronary Intervention: The Emerging Concept of Early Mechanical Reperfusion With Delayed Facilitated StentingWhen Earlier May Not Be Better", Drs. E. Marc Jolicoeur and Jean-François Tanguay argue that this alternative intervention has much reason to be supported and that new thinking and testing are needed to improve management of patients with acute myocardial infarction.
"If the authors are right, we need to change how we manage some heart attack patients to give them a better chance for a successful outcome. Additional studies will allow us to know for sure, but in the meantime it is important that doctors managing heart attack patients consider these findings and their potential implications," comments Stanley Nattel, MD, Editor-in-Chief of the Canadian Journal of Cardiology.
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The paper is "Effect of Delayed vs. Immediate Stent Implantation on Myocardial Perfusion and Cardiac Function in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention With Thrombus Aspiration," by Liang Tang, MD, Sheng-hua Zhou, MD, PhD, Xin-qun Hu, MD, Zhen-fei Fang, MD, and Xiang-qian Shen, MD (doi:10.1016/j.cjca.2011.03.001). It appears in Canadian Journal of Cardiology, Volume 27, Issue 5 (September 2011)