The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction: Ischemic postconditioning or deferred stent implantation versus conventional primary angioplasty and complete revascularization versus treatment of culprit lesion only: Rationale and design of the DANAMI 3 trial program

Dan Eik Høfsten; Henning Kelbæk; Steffen Helqvist; Lene Kløvgaard; Lene Holmvang; Peter Clemmensen; Christian Torp-Pedersen; Hans-Henrik Tilsted; Hans Erik Bøtker; Lisette Okkels Jensen; Lars Køber; Thomas Engstrøm; DANAMI-3 Investigators

doi:10.1016/j.ahj.2015.02.004

The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction: Ischemic postconditioning or deferred stent implantation versus conventional primary angioplasty and complete revascularization versus treatment of culprit lesion only: Rationale and design of the DANAMI 3 trial program

Dan Eik Høfsten, Henning Kelbæk, Steffen Helqvist, Lene Kløvgaard, Lene Holmvang, Peter Clemmensen, Christian Torp-Pedersen, Hans-Henrik Tilsted, Hans Erik Bøtker, Lisette Okkels Jensen, Lars Køber, Thomas Engstrøm, DANAMI-3 Investigators

Institut for Klinisk Medicin

55 Citationer (Scopus)

Abstract

BACKGROUND: In patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, ischemic postconditioning has been shown to reduce infarct size, but the effect on clinical outcome has not been tested in a large randomized trial. In addition, deferring stent implantation in the infarct-related lesion 1 to 3 days after acute opening of the infarct-related artery could have protective effects, by reducing the risk of injury caused by distal embolization and microvascular obstruction. Finally, a considerable fraction of patients present with lesions in other coronary artery branches than the infarct-related artery. Whether a strategy of complete or partial revascularization of these patients should be preferred remains uncertain.

STUDY DESIGN: The DANAMI 3 trial program was designed to investigate 3 different randomized treatment strategies in patients with ST-segment elevation myocardial infarction: (1) ischemic postconditioning versus conventional treatment with a primary end point of death and hospitalization for heart failure; (2) deferring stent implantation in the infarct-related lesion versus conventional treatment with a primary end point of death, hospitalization for heart failure, reinfarction, and repeat revascularization; and (3) treatment of the culprit lesion only versus fractional flow reserve-guided complete revascularization in patients with multivessel disease, with a primary end point of death, reinfarction, and repeat revascularization.

SUMMARY: The DANAMI 3 trial program will determine whether either of 2 approaches to reduce reperfusion injury and distal microvascular obstruction with postconditioning or deferred stent implantation will translate into improved clinical outcome and whether patients with multivessel disease undergoing primary percutaneous coronary intervention will benefit from a strategy of complete or partial revascularization.

Originalsprog	Engelsk
Tidsskrift	American Heart Journal
Vol/bind	169
Udgave nummer	5
Sider (fra-til)	613-21
Antal sider	9
ISSN	0002-8703
DOI	https://doi.org/10.1016/j.ahj.2015.02.004
Status	Udgivet - 1 maj 2015

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10.1016/j.ahj.2015.02.004

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Citationsformater

Høfsten, D. E., Kelbæk, H., Helqvist, S., Kløvgaard, L., Holmvang, L., Clemmensen, P., Torp-Pedersen, C., Tilsted, H-H., Bøtker, H. E., Jensen, L. O., Køber, L., Engstrøm, T., & DANAMI-3 Investigators (2015). The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction: Ischemic postconditioning or deferred stent implantation versus conventional primary angioplasty and complete revascularization versus treatment of culprit lesion only: Rationale and design of the DANAMI 3 trial program. American Heart Journal, 169(5), 613-21. https://doi.org/10.1016/j.ahj.2015.02.004

The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction : Ischemic postconditioning or deferred stent implantation versus conventional primary angioplasty and complete revascularization versus treatment of culprit lesion only: Rationale and design of the DANAMI 3 trial program. / Høfsten, Dan Eik; Kelbæk, Henning; Helqvist, Steffen et al.

I: American Heart Journal, Bind 169, Nr. 5, 01.05.2015, s. 613-21.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Høfsten, DE, Kelbæk, H, Helqvist, S, Kløvgaard, L, Holmvang, L, Clemmensen, P, Torp-Pedersen, C, Tilsted, H-H, Bøtker, HE, Jensen, LO, Køber, L, Engstrøm, T & DANAMI-3 Investigators 2015, 'The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction: Ischemic postconditioning or deferred stent implantation versus conventional primary angioplasty and complete revascularization versus treatment of culprit lesion only: Rationale and design of the DANAMI 3 trial program', American Heart Journal, bind 169, nr. 5, s. 613-21. https://doi.org/10.1016/j.ahj.2015.02.004

Høfsten DE, Kelbæk H, Helqvist S, Kløvgaard L, Holmvang L, Clemmensen P et al. The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction: Ischemic postconditioning or deferred stent implantation versus conventional primary angioplasty and complete revascularization versus treatment of culprit lesion only: Rationale and design of the DANAMI 3 trial program. American Heart Journal. 2015 maj 1;169(5):613-21. doi: 10.1016/j.ahj.2015.02.004

Høfsten, Dan Eik ; Kelbæk, Henning ; Helqvist, Steffen et al. / The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction : Ischemic postconditioning or deferred stent implantation versus conventional primary angioplasty and complete revascularization versus treatment of culprit lesion only: Rationale and design of the DANAMI 3 trial program. I: American Heart Journal. 2015 ; Bind 169, Nr. 5. s. 613-21.

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abstract = "BACKGROUND: In patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, ischemic postconditioning has been shown to reduce infarct size, but the effect on clinical outcome has not been tested in a large randomized trial. In addition, deferring stent implantation in the infarct-related lesion 1 to 3 days after acute opening of the infarct-related artery could have protective effects, by reducing the risk of injury caused by distal embolization and microvascular obstruction. Finally, a considerable fraction of patients present with lesions in other coronary artery branches than the infarct-related artery. Whether a strategy of complete or partial revascularization of these patients should be preferred remains uncertain.STUDY DESIGN: The DANAMI 3 trial program was designed to investigate 3 different randomized treatment strategies in patients with ST-segment elevation myocardial infarction: (1) ischemic postconditioning versus conventional treatment with a primary end point of death and hospitalization for heart failure; (2) deferring stent implantation in the infarct-related lesion versus conventional treatment with a primary end point of death, hospitalization for heart failure, reinfarction, and repeat revascularization; and (3) treatment of the culprit lesion only versus fractional flow reserve-guided complete revascularization in patients with multivessel disease, with a primary end point of death, reinfarction, and repeat revascularization.SUMMARY: The DANAMI 3 trial program will determine whether either of 2 approaches to reduce reperfusion injury and distal microvascular obstruction with postconditioning or deferred stent implantation will translate into improved clinical outcome and whether patients with multivessel disease undergoing primary percutaneous coronary intervention will benefit from a strategy of complete or partial revascularization.",

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T2 - Ischemic postconditioning or deferred stent implantation versus conventional primary angioplasty and complete revascularization versus treatment of culprit lesion only: Rationale and design of the DANAMI 3 trial program

AU - Høfsten, Dan Eik

AU - Kelbæk, Henning

AU - Helqvist, Steffen

AU - Kløvgaard, Lene

AU - Holmvang, Lene

AU - Clemmensen, Peter

AU - Torp-Pedersen, Christian

AU - Tilsted, Hans-Henrik

AU - Bøtker, Hans Erik

AU - Jensen, Lisette Okkels

AU - Køber, Lars

AU - Engstrøm, Thomas

AU - DANAMI-3 Investigators

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N2 - BACKGROUND: In patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, ischemic postconditioning has been shown to reduce infarct size, but the effect on clinical outcome has not been tested in a large randomized trial. In addition, deferring stent implantation in the infarct-related lesion 1 to 3 days after acute opening of the infarct-related artery could have protective effects, by reducing the risk of injury caused by distal embolization and microvascular obstruction. Finally, a considerable fraction of patients present with lesions in other coronary artery branches than the infarct-related artery. Whether a strategy of complete or partial revascularization of these patients should be preferred remains uncertain.STUDY DESIGN: The DANAMI 3 trial program was designed to investigate 3 different randomized treatment strategies in patients with ST-segment elevation myocardial infarction: (1) ischemic postconditioning versus conventional treatment with a primary end point of death and hospitalization for heart failure; (2) deferring stent implantation in the infarct-related lesion versus conventional treatment with a primary end point of death, hospitalization for heart failure, reinfarction, and repeat revascularization; and (3) treatment of the culprit lesion only versus fractional flow reserve-guided complete revascularization in patients with multivessel disease, with a primary end point of death, reinfarction, and repeat revascularization.SUMMARY: The DANAMI 3 trial program will determine whether either of 2 approaches to reduce reperfusion injury and distal microvascular obstruction with postconditioning or deferred stent implantation will translate into improved clinical outcome and whether patients with multivessel disease undergoing primary percutaneous coronary intervention will benefit from a strategy of complete or partial revascularization.

AB - BACKGROUND: In patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, ischemic postconditioning has been shown to reduce infarct size, but the effect on clinical outcome has not been tested in a large randomized trial. In addition, deferring stent implantation in the infarct-related lesion 1 to 3 days after acute opening of the infarct-related artery could have protective effects, by reducing the risk of injury caused by distal embolization and microvascular obstruction. Finally, a considerable fraction of patients present with lesions in other coronary artery branches than the infarct-related artery. Whether a strategy of complete or partial revascularization of these patients should be preferred remains uncertain.STUDY DESIGN: The DANAMI 3 trial program was designed to investigate 3 different randomized treatment strategies in patients with ST-segment elevation myocardial infarction: (1) ischemic postconditioning versus conventional treatment with a primary end point of death and hospitalization for heart failure; (2) deferring stent implantation in the infarct-related lesion versus conventional treatment with a primary end point of death, hospitalization for heart failure, reinfarction, and repeat revascularization; and (3) treatment of the culprit lesion only versus fractional flow reserve-guided complete revascularization in patients with multivessel disease, with a primary end point of death, reinfarction, and repeat revascularization.SUMMARY: The DANAMI 3 trial program will determine whether either of 2 approaches to reduce reperfusion injury and distal microvascular obstruction with postconditioning or deferred stent implantation will translate into improved clinical outcome and whether patients with multivessel disease undergoing primary percutaneous coronary intervention will benefit from a strategy of complete or partial revascularization.

KW - Adult

KW - Angioplasty, Balloon, Coronary

KW - Heart Failure

KW - Hospitalization

KW - Humans

KW - Ischemic Postconditioning

KW - Myocardial Infarction

KW - Recurrence

KW - Research Design

KW - Stents

U2 - 10.1016/j.ahj.2015.02.004

DO - 10.1016/j.ahj.2015.02.004

M3 - Journal article

C2 - 25965708

SN - 0002-8703

VL - 169

SP - 613

EP - 621

JO - American Heart Journal

JF - American Heart Journal

IS - 5

ER -