10-Year Outcomes of Deferred or Conventional Stent Implantation in Patients With STEMI (DANAMI-3-DEFER).

IF 7.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Interventions Pub Date : 2025-06-01 Epub Date: 2025-05-20 DOI:10.1161/CIRCINTERVENTIONS.125.015369

Jasmine Melissa Marquard, Thomas Engstrøm, Henning Kelbæk, Rasmus Paulin Beske, Utsho Islam, Dan Eik Høfsten, Lene Holmvang, Frants Pedersen, Christian Juhl Terkelsen, Evald Høj Christiansen, Hans-Henrik Tilsted, Charlotte Glinge, Reza Jabbari, Ashkan Eftekhari, Bent Raungaard, Peter Clemmensen, Hans Erik Bøtker, Lisette Okkels Jensen, Lars Køber, Jacob Thomsen Lønborg

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引用次数: 0

Abstract

Background: Primary percutaneous coronary intervention (PCI) with stenting is recommended in ST-segment-elevation myocardial infarction. Immediate stenting may cause distal embolization, microvascular damage, and flow disturbances, leading to adverse outcomes. We report the 10-year clinical outcomes of deferred stenting versus conventional PCI in patients with ST-segment-elevation myocardial infarction.

Methods: We conducted a 10-year follow-up study of the open-label, randomized DANAMI-3-DEFER trial (Third Danish Study of Optimal Acute Treatment of Patients With STEMI - Deferred Stent Implantation Versus Conventional Treatment), conducted in 4 PCI centers in Denmark. Patients with ST-segment-elevation myocardial infarction and acute chest pain <12 hours were randomized to deferred stenting >24 hours after the index procedure or conventional PCI with immediate stenting. In the deferred group, immediate stable Thrombolysis in Myocardial Infarction flow II to III was established, and intravenous administration of either a glycoprotein IIb/IIIa antagonist or bivalirudin for >4 hours after the index procedure was recommended. The primary outcome was a composite of hospitalization for heart failure or all-cause mortality. Key secondary outcomes included individual components of the primary outcome and target vessel revascularization.

Results: Of 1215 patients, 603 were randomized to deferred stenting and 612 to conventional PCI. After 10 years, deferred stenting did not significantly reduce the primary composite outcome (hazard ratio, 0.82 [95% CI, 0.67-1.02]; P=0.08). In the deferred group, 124 (24%) died versus 150 (25%) in the conventional PCI group (hazard ratio, 0.95 [95% CI, 0.75-1.19]). Hospitalization for heart failure was lower in patients treated with deferred stenting compared with conventional PCI (odds ratio, 0.58 [95% CI, 0.39-0.88]). Target vessel revascularization was similar in both groups (odds ratio, 1.20 [95% CI, 0.81-1.79]).

Conclusions: Deferred stenting did not reduce all-cause mortality or the composite primary outcome after 10 years but reduced hospitalization for heart failure compared with conventional PCI.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01435408.

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STEMI患者延期或常规支架植入术的10年结果（DANAMI-3-DEFER）

背景：经皮冠状动脉介入治疗（PCI）和支架植入术被推荐用于st段抬高型心肌梗死。立即支架置入可能导致远端栓塞、微血管损伤和血流紊乱，导致不良后果。我们报告了st段抬高型心肌梗死患者延期支架置入与传统PCI的10年临床结果。方法：我们在丹麦的4个PCI中心进行了一项开放标签、随机的DANAMI-3-DEFER试验（第三次丹麦STEMI延期支架植入患者与常规治疗的最佳急性治疗研究）的10年随访研究。st段抬高型心肌梗死和急性胸痛患者在指数手术或常规PCI即刻支架术后24小时。在延迟组中，在心肌梗死II至III流中建立了立即稳定的溶栓，并建议在指标程序后静脉给予糖蛋白IIb/IIIa拮抗剂或比伐鲁定40小时。主要结局是因心力衰竭住院或全因死亡率的综合结果。主要次要结局包括主要结局的各个组成部分和靶血管重建。结果：1215例患者中，603例随机接受延期支架置入，612例随机接受常规PCI。10年后，延期支架植入并没有显著降低主要综合结局(风险比，0.82 [95% CI, 0.67-1.02]；P = 0.08)。延期治疗组有124例（24%）死亡，而常规PCI治疗组有150例（25%）死亡（风险比0.95 [95% CI, 0.75-1.19]）。与传统PCI相比，延期支架置入术患者因心力衰竭住院率较低（优势比为0.58 [95% CI, 0.39-0.88]）。两组靶血管重建术相似（优势比为1.20 [95% CI, 0.81-1.79]）。结论：与传统PCI相比，延期支架植入并没有降低10年后的全因死亡率或复合主要结局，但减少了心力衰竭的住院率。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT01435408。

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来源期刊

Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

1.80%

发文量

221

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.