Primary Reperfusion Secondary Stenting Trial

The PRIMACY trial seeks to assess whether a strategy of delayed stent implantation combined with adjunctive anticoagulation is superior to immediate stent implantation at improving cardiovascular outcomes in patients with mechanically reperfused ST-elevation Myocardial Infarction (STEMI). The investigators hypothesize that delayed stent implantation combined with systemic anticoagulation and maximal antiplatelet therapy will reduce the combined occurrence of cardiac death, non-fatal myocardial infarction, congestive heart failure, or unplanned target vessel revascularization over a 9-month period.

Inclusion criteria

• Age between 18 and 80 years;
• STEMI, presenting within 12 hours of symptoms onset, and persisting for more than 20 minutes;
• ECG that fulfills any of the following criteria: ≥ 2 mm ST elevation in two anterior or lateral leads; or ≥ 1 mm ST elevation in two inferior leads; or new left bundle branch block (LBBB) with at least 1 mm concordant ST elevation;
• Infarct-related artery with TIMI flow 0 or 1 at baseline angiogram;
• Successful reperfusion (TIMI 2-3 flow), either spontaneously or after wire passage, thrombectomy, small size (≤ 2.0mm) angioplasty catheter, and persisting for more than 10 minutes;
• Infarct related artery with a diameter above 2.5 mm.

Exclusion criteria

• Prior STEMI in the qualifying coronary artery;
• Coronary dissection following reperfusion;
• STEMI caused by acute stent thrombosis or a venous or arterial bypass graft occlusion;
• Significant left main disease, as determined by angiography (≥ 50%) or other imaging technologies;
• Cardiac condition requiring emergent or urgent surgical repair;
• Failed thrombolysis and rescue PCI;
• High risk of bleeding;
• Contraindication to either ticagrelor or GpIIb/IIIa inhibitors;
• STEMI with Killip III-IV or cardiogenic shock or presenting as sudden death, ventricular fibrillation, or sustained ventricular tachycardia;
• Women who are pregnant or breastfeeding;
• Creatinine clearance < 20 ml/min;
• Other contraindication to PCI;
• Participation with another investigational drug or investigational device study within 30 days prior to randomization (participation to registries is allowed);
• Any condition that in the opinion of the investigator would preclude compliance with the study protocol.