In 10 Years, No Big Gains With Deferred Stenting in STEMI?
A 10-year follow-up study confirmed that compared with conventional immediate percutaneous coronary intervention (PCI), deferred stenting in patients with ST-segment elevation myocardial infarction (STEMI) did not reduce the composite of all-cause mortality or hospitalisation for heart failure (HF) but was associated with a reduction in hospitalisation for HF.
METHODOLOGY:
The multicentre DANAMI-3-DEFER trial in Denmark (March 2011 to February 2014) found no significant clinical benefits of deferred stenting over conventional PCI with immediate stenting for patients with STEMI; rather, it was associated with an increased risk for target vessel revascularisation.
Researchers conducted a post hoc analysis of the trial to assess 10-year outcomes, evaluating 1215 patients with STEMI and acute chest pain for less than 12 hours from symptom onset.
Patients were randomly assigned to receive either deferred stenting (n = 603), performed 24-48 hours after the initial PCI, or conventional PCI (n = 612), involving stent placement immediately after PCI.
The primary outcome was a composite of hospitalisation for HF or all-cause mortality.
TAKEAWAY:
The 10-year cumulative incidence of hospitalisation for HF or all-cause mortality was not significantly different between patients in the deferred stenting group and those in the conventional PCI group.
Hospitalisation for HF was 42% lower in the deferred stenting group than in the conventional PCI group (odds ratio, 0.58; P = .010).
= .010). No significant differences in target vessel revascularisation were observed between the two groups.
IN PRACTICE:
"Unlike earlier findings, the extended follow-up showed that the increased incidence of target vessel revascularization in the deferred stenting group observed in the DANAMI-3-DEFER main trial appeared to diminish in the long-term," the authors of the study wrote.
SOURCE:
This study was led by Jasmine Melissa Marquard, MD, Copenhagen University Hospital, Copenhagen, Denmark. It was published online on May 20, 2025, in Circulation: Cardiovascular Interventions .
LIMITATIONS:
Owing to the open-label design of this trial, patients and treating physicians were aware of the treatments, which might have introduced biases. The findings should be interpreted with caution, especially considering the small sample size and the post hoc nature of the analysis.
DISCLOSURES:
The DANAMI-3-DEFER trial received funding from the Danish Agency for Science, Technology and Innovation and the Danish Council for Strategic Research. Additional disclosures are noted in the original article. Several authors reported receiving honoraria, advisory board fees, speaker fees, and grants from multiple pharmaceutical and medical technology companies, including AstraZeneca, Novartis, and Biotronik.
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