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

Jacob Lønborg; Thomas Engstrøm; Kiril Aleksov Ahtarovski; Lars Nepper-Christensen; Steffen Helqvist; Niels Vejlstrup; Kasper Kyhl; Mikkel Malby Schoos; Ali Ghotbi; Christoffer Göransson; Litten Bertelsen; Lene Holmvang; Frants Pedersen; Erik Jørgensen; Kari Saunamäki; Peter Clemmensen; Ole De Backer; Lene Kløvgaard; Dan Eik Høfsten; Lars Køber; Henning Kelbæk; DANAMI-3 Investigators

doi:10.1016/j.jacc.2017.03.601

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

Jacob Lønborg, Thomas Engstrøm, Kiril Aleksov Ahtarovski, Lars Nepper-Christensen, Steffen Helqvist, Niels Vejlstrup, Kasper Kyhl, Mikkel Malby Schoos, Ali Ghotbi, Christoffer Göransson, Litten Bertelsen, Lene Holmvang, Frants Pedersen, Erik Jørgensen, Kari Saunamäki, Peter Clemmensen, Ole De Backer, Lene Kløvgaard, Dan Eik Høfsten, Lars KøberHenning Kelbæk, DANAMI-3 Investigators

Department of Cardiology

38 Citations (Scopus)

Abstract

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. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408).

Original language	English
Journal	Journal of the American College of Cardiology
Volume	69
Issue number	23
Pages (from-to)	2794-2804
Number of pages	11
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2017.03.601
Publication status	Published - 13 Jun 2017

Keywords

Coronary Circulation
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging, Cine
Male
Microcirculation
Middle Aged
Myocardium
Percutaneous Coronary Intervention
ST Elevation Myocardial Infarction
Severity of Illness Index
Stents
Time Factors
Treatment Outcome
Journal Article
Randomized Controlled Trial

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10.1016/j.jacc.2017.03.601

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Lønborg, J., Engstrøm, T., Ahtarovski, K. A., Nepper-Christensen, L., Helqvist, S., Vejlstrup, N., Kyhl, K., Schoos, M. M., Ghotbi, A., Göransson, C., Bertelsen, L., Holmvang, L., Pedersen, F., Jørgensen, E., Saunamäki, K., Clemmensen, P., De Backer, O., Kløvgaard, L., Høfsten, D. E., ... DANAMI-3 Investigators (2017). Myocardial Damage in Patients With Deferred Stenting After STEMI: A DANAMI-3-DEFER Substudy. Journal of the American College of Cardiology, 69(23), 2794-2804. https://doi.org/10.1016/j.jacc.2017.03.601

Lønborg, J , Engstrøm, T , Ahtarovski, KA , Nepper-Christensen, L , Helqvist, S , Vejlstrup, N , Kyhl, K , Schoos, MM, Ghotbi, A, Göransson, C , Bertelsen, L , Holmvang, L , Pedersen, F , Jørgensen, E, Saunamäki, K, Clemmensen, P, De Backer, O , Kløvgaard, L , Høfsten, DE , Køber, L, Kelbæk, H & DANAMI-3 Investigators 2017, 'Myocardial Damage in Patients With Deferred Stenting After STEMI: A DANAMI-3-DEFER Substudy', Journal of the American College of Cardiology, vol. 69, no. 23, pp. 2794-2804. https://doi.org/10.1016/j.jacc.2017.03.601

@article{2ea94e48568d461ebe06062ef5c02b28,

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

abstract = "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. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408).",

keywords = "Coronary Circulation, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Cine, Male, Microcirculation, Middle Aged, Myocardium, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction, Severity of Illness Index, Stents, Time Factors, Treatment Outcome, Journal Article, Randomized Controlled Trial",

author = "Jacob L{\o}nborg and Thomas Engstr{\o}m and Ahtarovski, {Kiril Aleksov} and Lars Nepper-Christensen and Steffen Helqvist and Niels Vejlstrup and Kasper Kyhl and Schoos, {Mikkel Malby} and Ali Ghotbi and Christoffer G{\"o}ransson and Litten Bertelsen and Lene Holmvang and Frants Pedersen and Erik J{\o}rgensen and Kari Saunam{\"a}ki and Peter Clemmensen and {De Backer}, Ole and Lene Kl{\o}vgaard and H{\o}fsten, {Dan Eik} and Lars K{\o}ber and Henning Kelb{\ae}k and {DANAMI-3 Investigators}",

year = "2017",

month = jun,

day = "13",

doi = "10.1016/j.jacc.2017.03.601",

language = "English",

volume = "69",

pages = "2794--2804",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc",

number = "23",

}

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, 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 - Høfsten, Dan Eik

AU - Køber, Lars

AU - Kelbæk, Henning

AU - DANAMI-3 Investigators

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. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408).

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. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408).

KW - Coronary Circulation

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Magnetic Resonance Imaging, Cine

KW - Male

KW - Microcirculation

KW - Middle Aged

KW - Myocardium

KW - Percutaneous Coronary Intervention

KW - ST Elevation Myocardial Infarction

KW - Severity of Illness Index

KW - Stents

KW - Time Factors

KW - Treatment Outcome

KW - Journal Article

KW - Randomized Controlled Trial

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 -

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

Abstract

Keywords

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