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| Turkish Society of Cardiology Young Cardiologists Bulletin Year: 8 Number: 3 / 2025 |
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Prepared by: Dr. Aysu Oktay Name of the study: Deferred or conventional stenting in patients with STEMI: 10-year outcome of DANAMI-3-DEFER Published in: EuroPCR 2025 Background Immediate stenting in ST-segment elevation myocardial infarction (STEMI) patients can lead to microvascular damage and the development of heart failure. The deferred stenting strategy aims to reduce these complications. The DANAMI-3-DEFER study was conducted to investigate the long-term efficacy of this approach. Objective To assess whether deferred stenting provides superior outcomes compared to immediate stenting in terms of mortality and heart failure hospitalizations over a 10-year follow-up period. Methods A total of 1,215 patients diagnosed with STEMI were included. Patients were randomized to either deferred stenting (>24 hours later) or immediate stenting groups. The DANAMI-3-DEFER study was an open-label, two-arm randomized controlled trial conducted across four primary percutaneous coronary intervention (PCI) centers in Denmark. In the deferred group, the infarct-related artery was initially opened with balloon and thrombectomy as needed, without stenting. These patients received intravenous antithrombotic therapy (GP IIb/IIIa inhibitor or bivalirudin) for at least 4 hours after the procedure, and underwent a second PCI session with stenting >24 hours later (typically within ~48 hours). In the conventional stenting group, the lesion was stented during the initial procedure. Interestingly, in the deferred group, 15% of patients did not require stent implantation during the second session as the lesion had resolved spontaneously, compared to only 3% in the immediate stenting group. All patients were followed for approximately 10 years via national registries. Primary Endpoint A composite of all-cause mortality or hospitalization for heart failure. Results • No significant difference in the primary endpoint (HR 0.82; p=0.08). Subgroup Findings Deferred stenting showed marked benefit in patients with anterior myocardial infarction. In LAD-related STEMI cases, the rate of hospitalization for heart failure was approximately 40% lower in the deferred group compared to the conventional group. Clinical Interpretation and Conclusion Deferred stenting did not reduce long-term mortality in the general population. According to the 10-year results of the DANAMI-3-DEFER study, delaying stent implantation during primary PCI did not significantly reduce all-cause mortality or major adverse cardiac events compared to immediate stenting. However, the deferred strategy significantly reduced the risk of heart failure hospitalization in patients with LAD-related STEMI. These findings suggest a potential long-term benefit particularly in anterior MI patients. The clinical benefit is primarily attributed to reduced slow flow and distal embolization.
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