الفهرس 
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Abstract
One of the major complications, which can occur during primary PCI is distal embolization. Macroscopic distal embolization occurs in 10% to 20% of patients, and markedly increases infarct size and mortality. Microscopic embolization is even more frequent, and may contribute to suboptimal restoration of myocardial perfusion in more than one-third of patients after primary PCI, despite restoration of TIMI-3 epicardial flow. Abnormal myocardial perfusion may readily be recognized after primary PCI either by absent myocardial blush or incomplete ST-segment resolution.
A mounting body of evidence suggests that delaying stent implantation may be superior to traditional primary stenting in thrombus-laden coronary arteries. In this setting, stent implantation may be deferred until adjunctive anticoagulation and antiplatelet therapy have allowed thrombus burden meltdown.
The aim of the current study was to improve the outcomes of primary PCI in patients suffering ST- elevation myocardial infarction, decrease the incidence of no-reflow, and accordingly improve the rate of myocardial function recovery for such patients.
The study objectives were set to Compare between three groups of patients undergoing primary PCI after suffering ST- elevation myocardial infarction with an intention to stent either 4 to 16 hours later (1st group), 7 days later (2nd group), or immediate stenting after recanalization of the infarct related artery, in regard to the incidence of no/slow-reflow, angiographic parameters i.e. MBG, echocardiographic parameters i.e. EF by Simpsons’ and 6 months MACE follow up.
The study hypothesized that stent implantation deferral in primary PCI, would decrease the incidence of no-reflow and increase the rate of myocardial function recovery giving time to anticoagulants and antiplatelets to help in thrombus resolution.
This study included 150 Patients presenting to the ER of national heart institute with STEMI and undergoing primary PCI with angiographically evident high thrombus burden (TIMI thrombus grade 2-5) divided evenly between the three mentioned groups.
The study passed through the following phases:
1- STEMI patients undergoing primary PCI were recruited according to their thrombus burden.
2- Primary coronary intervention, with definite management in the 3rd group and deferral of stent implantation in the two other groups.
3- Patients of the 1st and the 2nd groups will receive evidence based medical management during the interval of deferral with IV infusion of GP IIb/IIIa inhibitors.
4- Secondary coronary intervention with stent implantation if needed.
5- 6 months follow-up for MACE and repeat echocardiography.