Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): an open-label, randomised controlled trial
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Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): an open-label, randomised controlled trial. / Kelbæk, Henning; Høfsten, Dan Eik; Køber, Lars; Helqvist, Steffen; Kløvgaard, Lene; Holmvang, Lene; Jørgensen, Erik; Pedersen, Frants; Saunamäki, Kari; De Backer, Ole; Bang, Lia E; Kofoed, Klaus F; Lønborg, Jacob; Ahtarovski, Kiril; Vejlstrup, Niels; Bøtker, Hans E; Terkelsen, Christian J; Christiansen, Evald H; Ravkilde, Jan; Tilsted, Hans-Henrik; Villadsen, Anton B; Aarøe, Jens; Jensen, Svend E; Raungaard, Bent; Jensen, Lisette O; Clemmensen, Peter; Grande, Peer; Madsen, Jan K; Torp-Pedersen, Christian; Engstrøm, Thomas.
In: LANCET, Vol. 387, No. 10034, 28.05.2016, p. 2199-1206.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): an open-label, randomised controlled trial
AU - Kelbæk, Henning
AU - Høfsten, Dan Eik
AU - Køber, Lars
AU - Helqvist, Steffen
AU - Kløvgaard, Lene
AU - Holmvang, Lene
AU - Jørgensen, Erik
AU - Pedersen, Frants
AU - Saunamäki, Kari
AU - De Backer, Ole
AU - Bang, Lia E
AU - Kofoed, Klaus F
AU - Lønborg, Jacob
AU - Ahtarovski, Kiril
AU - Vejlstrup, Niels
AU - Bøtker, Hans E
AU - Terkelsen, Christian J
AU - Christiansen, Evald H
AU - Ravkilde, Jan
AU - Tilsted, Hans-Henrik
AU - Villadsen, Anton B
AU - Aarøe, Jens
AU - Jensen, Svend E
AU - Raungaard, Bent
AU - Jensen, Lisette O
AU - Clemmensen, Peter
AU - Grande, Peer
AU - Madsen, Jan K
AU - Torp-Pedersen, Christian
AU - Engstrøm, Thomas
N1 - Copyright © 2016 Elsevier Ltd. All rights reserved.
PY - 2016/5/28
Y1 - 2016/5/28
N2 - BACKGROUND: Despite successful treatment of the culprit artery lesion by primary percutaneous coronary intervention (PCI) with stent implantation, thrombotic embolisation occurs in some cases, which impairs the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). We aimed to assess the clinical outcomes of deferred stent implantation versus standard PCI in patients with STEMI.METHODS: We did this open-label, randomised controlled trial at four primary PCI centres in Denmark. Eligible patients (aged >18 years) had acute onset symptoms lasting 12 h or less, and ST-segment elevation of 0·1 mV or more in at least two or more contiguous electrocardiographic leads or newly developed left bundle branch block. Patients were randomly assigned (1:1), via an electronic web-based system with permuted block sizes of two to six, to receive either standard primary PCI with immediate stent implantation or deferred stent implantation 48 h after the index procedure if a stabilised flow could be obtained in the infarct-related artery. The primary endpoint was a composite of all-cause mortality, hospital admission for heart failure, recurrent infarction, and any unplanned revascularisation of the target vessel within 2 years' follow-up. Patients, investigators, and treating clinicians were not masked to treatment allocation. We did analysis by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01435408.FINDINGS: Between March 1, 2011, and Feb 28, 2014, we randomly assigned 1215 patients to receive either standard PCI (n=612) or deferred stent implantation (n=603). Median follow-up time was 42 months (IQR 33-49). Events comprising the primary endpoint occurred in 109 (18%) patients who had standard PCI and in 105 (17%) patients who had deferred stent implantation (hazard ratio 0·99, 95% CI 0·76-1·29; p=0·92). Procedure-related myocardial infarction, bleeding requiring transfusion or surgery, contrast-induced nephopathy, or stroke occurred in 28 (5%) patients in the conventional PCI group versus 27 (4%) patients in the deferred stent implantation group, with no significant differences between groups.INTERPRETATION: In patients with STEMI, routine deferred stent implantation did not reduce the occurrence of death, heart failure, myocardial infarction, or repeat revascularisation compared with conventional PCI. Results from ongoing randomised trials might shed further light on the concept of deferred stenting in this patient population.FUNDING: Danish Agency for Science, Technology and Innovation, and Danish Council for Strategic Research.
AB - BACKGROUND: Despite successful treatment of the culprit artery lesion by primary percutaneous coronary intervention (PCI) with stent implantation, thrombotic embolisation occurs in some cases, which impairs the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). We aimed to assess the clinical outcomes of deferred stent implantation versus standard PCI in patients with STEMI.METHODS: We did this open-label, randomised controlled trial at four primary PCI centres in Denmark. Eligible patients (aged >18 years) had acute onset symptoms lasting 12 h or less, and ST-segment elevation of 0·1 mV or more in at least two or more contiguous electrocardiographic leads or newly developed left bundle branch block. Patients were randomly assigned (1:1), via an electronic web-based system with permuted block sizes of two to six, to receive either standard primary PCI with immediate stent implantation or deferred stent implantation 48 h after the index procedure if a stabilised flow could be obtained in the infarct-related artery. The primary endpoint was a composite of all-cause mortality, hospital admission for heart failure, recurrent infarction, and any unplanned revascularisation of the target vessel within 2 years' follow-up. Patients, investigators, and treating clinicians were not masked to treatment allocation. We did analysis by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01435408.FINDINGS: Between March 1, 2011, and Feb 28, 2014, we randomly assigned 1215 patients to receive either standard PCI (n=612) or deferred stent implantation (n=603). Median follow-up time was 42 months (IQR 33-49). Events comprising the primary endpoint occurred in 109 (18%) patients who had standard PCI and in 105 (17%) patients who had deferred stent implantation (hazard ratio 0·99, 95% CI 0·76-1·29; p=0·92). Procedure-related myocardial infarction, bleeding requiring transfusion or surgery, contrast-induced nephopathy, or stroke occurred in 28 (5%) patients in the conventional PCI group versus 27 (4%) patients in the deferred stent implantation group, with no significant differences between groups.INTERPRETATION: In patients with STEMI, routine deferred stent implantation did not reduce the occurrence of death, heart failure, myocardial infarction, or repeat revascularisation compared with conventional PCI. Results from ongoing randomised trials might shed further light on the concept of deferred stenting in this patient population.FUNDING: Danish Agency for Science, Technology and Innovation, and Danish Council for Strategic Research.
KW - Adrenergic beta-Antagonists/administration & dosage
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Calcium Channel Blockers/administration & dosage
KW - Drug-Eluting Stents
KW - Female
KW - Humans
KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/therapy
KW - Percutaneous Coronary Intervention/methods
KW - Platelet Aggregation Inhibitors/administration & dosage
U2 - 10.1016/S0140-6736(16)30072-1
DO - 10.1016/S0140-6736(16)30072-1
M3 - SCORING: Journal article
C2 - 27053444
VL - 387
SP - 2199
EP - 1206
JO - LANCET
JF - LANCET
SN - 0140-6736
IS - 10034
ER -