Myocardial Damage in Patients With Deferred Stenting After STEMI: A DANAMI-3-DEFER Substudy

TY - JOUR

T1 - Myocardial Damage in Patients With Deferred Stenting After STEMI

T2 - A DANAMI-3-DEFER Substudy

AU - Lønborg, Jacob

AU - Engstrøm, Thomas

AU - Ahtarovski, Kiril Aleksov

AU - Nepper-Christensen, Lars

AU - Helqvist, Steffen

AU - Vejlstrup, Niels

AU - Kyhl, Kasper

AU - Schoos, Mikkel Malby

AU - Ghotbi, Adam Ali

AU - Göransson, Christoffer

AU - Bertelsen, Litten

AU - Holmvang, Lene

AU - Pedersen, Frants

AU - Jørgensen, Erik

AU - Saunamäki, Kari

AU - Clemmensen, Peter

AU - De Backer, Ole

AU - Kløvgaard, Lene

AU - Hoefsten, Dan Eik

AU - Køber, Lars

AU - Kelbæk, Henning

AU - DANAMI-3 Investigators

N1 - Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2017/6/13

Y1 - 2017/6/13

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1016/j.jacc.2017.03.601

DO - 10.1016/j.jacc.2017.03.601

M3 - Journal article

C2 - 28595694

SN - 0735-1097

VL - 69

SP - 2794

EP - 2804

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 23

ER -