Author + information
- Received February 10, 2017
- Revision received March 14, 2017
- Accepted March 29, 2017
- Published online June 5, 2017.
- Jacob Lønborg, MD, PhD, DMSca,∗ (, )
- Thomas Engstrøm, MD, PhD, DMSca,
- Kiril Aleksov Ahtarovski, MD, PhDa,
- Lars Nepper-Christensen, MDa,
- Steffen Helqvist, MD, DMSca,
- Niels Vejlstrup, MD, PhDa,
- Kasper Kyhl, MDa,
- Mikkel Malby Schoos, MD, PhDa,
- Ali Ghotbi, MDa,
- Christoffer Göransson, MDa,
- Litten Bertelsen, MDa,
- Lene Holmvang, MD, DMSca,
- Frants Pedersen, MD, PhDa,
- Erik Jørgensen, MDa,
- Kari Saunamäki, MD, DMSca,
- Peter Clemmensen, MD, DMScb,c,
- Ole De Backer, MD, PhDa,
- Lene Kløvgaard, RNa,
- Dan Eik Høfsten, MD, PhDa,
- Lars Køber, MD, DMSca,
- Henning Kelbæk, MD, DMScd,
- DANAMI-3 Investigators
- aDepartment of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- bDepartment of Medicine, Division of Cardiology, Nykøbing F Hospital, Nykøbing F, Denmark
- cDepartment of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
- dDepartment of Cardiology, Zealand University Hospital, Roskilde, Denmark
- ↵∗Address for correspondence:
Dr. Jacob Lønborg, Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Background Although some studies found improved coronary flow and myocardial salvage when stent implantation was deferred, the DANAMI-3–DEFER (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) did not show any improvement in clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) and deferred stenting.
Objectives This study sought to evaluate the effect of deferred stent implantation on infarct size, myocardial salvage, and microvascular obstruction (MVO) in patients with STEMI.
Methods In the present DANAMI-3 substudy, a total of 510 patients with STEMI were randomized to PCI with deferred versus immediate stent implantation. The patients underwent a cardiac magnetic resonance examination before discharge after the index procedure and again 3 months later. The primary endpoint was final infarct size.
Results Deferred stenting did not reduce final infarct size (9% left ventricle [LV]; interquartile range [IQR]: 3% to 18% vs. 10% LV; IQR: 3% to 18%; p = 0.67). Similarly, deferred stenting was not associated with myocardial salvage index (66%; IQR: 50% to 89% vs. 67%; IQR: 49% to 88%; p = 0.80) or presence of MVO (43% vs. 42%; p = 0.78). In a post hoc analysis, stent length was the only subgroup of 7 that had an effect on outcome. In patients with a stent length ≥24 mm, deferred stenting reduced the final infarct size (6% LV; IQR: 2% to 18% vs. 13% LV; IQR: 7% to 23%; p = 0.006; and p for interaction = 0.005).
Conclusions In the DANAMI-3–DEFER cardiac magnetic resonance substudy, routine deferred stenting did not reduce infarct size or MVO and did not increase myocardial salvage. These results do not support the use of routine deferred stenting in STEMI patients treated with primary PCI. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408)
This work was supported by the Danish Agency for Science, Technology and Innovation and the Danish Council for Strategic Research, grant 09-066994. Dr. Lønborg has presented lectures for St. Jude Medical. Dr. Engstrøm has received speakers fees from St. Jude Medical and Boston Scientific; and has served on the advisory board of AstraZeneca and Bayer A/S. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 10, 2017.
- Revision received March 14, 2017.
- Accepted March 29, 2017.
- 2017 American College of Cardiology Foundation