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; Backer, Ole De; Bang, Lia E.; Kofoed, Klaus F.; Lønborg, Jacob; Ahtarovski, Kiril Aleksov; Vejlstrup, Niels; Bøtker, Hans Erik; Terkelsen, Christian Juhl; Christiansen, Evald Høj; Ravkilde, Jan; Tilsted, Hans‐Henrik; Villadsen, Anton Boel; Aarøe, Jens; Jensen, Svend Eggert; Raungaard, Bent; Jensen, Lisette Okkels; Clemmensen, Peter; Grande, Peer; Madsen, Jan Kyst; Torp‐Pedersen, Christian; Engstrøm, Thomas

doi:10.1016/s0140-6736(16)30072-1

Cited by 165 publications

(122 citation statements)

References 28 publications

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“…(9)(10)(11) Our patient had simultaneous thrombosis in LAD and RCA, which did not fulfil the criteria of the DEFER trials. Currently, there are no guidelines for optimal management strategy …”

Section: A 2bmentioning

confidence: 94%

Double jeopardy in acute ST-segment elevation myocardial infarction

Ananthakrishna

Wang

Zhao

et al. 2017

smedj

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L e t t e r t o t h e E d i t o r 225Dear Sir, Acute multi-coronary thrombotic occlusion is an uncommon presentation of ST-segment elevation myocardial infarction (STEMI). Only a few reports of this condition have been published to date and the appropriate management options are unclear.(1) The present report draws attention to simultaneous coronary thrombosis in the right coronary artery (RCA) and left anterior descending artery (LAD) and discusses the possible mechanism and treatment strategy.A 51-year-old man presented with typical chest pain of four hours' duration and pulmonary oedema. His cardiovascular risk factors included Type 2 diabetes mellitus, hypertension, dyslipidaemia and smoking (ten cigarettes per day for the past 20 years). The patient received intranasal oxygen therapy, intravenous morphine and furosemide in the emergency department. A loading dose of aspirin 300 mg and clopidogrel 600 mg was administered. Electrocardiography revealed ST-segment elevation in the inferior leads. Coronary angiograms showed a thrombotic occlusion of the mid-RCA and the proximal LAD, with thrombolysis in myocardial infarction (TIMI) 0 flow (Figs. 1a & b).Primary percutaneous coronary intervention (PCI) was performed via a 7 French (Fr) sheath in the right common femoral artery. The patient received heparin anticoagulation during PCI, guided by an activated clotting time. Initial results with plain balloon angioplasty were unsatisfactory for both the lesions, with a large thrombus burden. Thrombus was aspirated from the RCA and the LAD with a 7 Fr Thrombuster aspiration catheter (Kaneka Medix Corp, Shinagawa-ku, Tokyo, Japan). TIMI 3 flow was achieved in both the arteries, with a residual stenosis of 50%-60% in the mid-RCA and 60%-70% in the mid-LAD (Figs. 2a & b). The coronary arteries were ectatic. An intra-aortic balloon pump was inserted for haemodynamic stability. During PCI, the patient had also received two boluses of eptifibatide (180 µg/kg given ten minutes apart), followed by an infusion for 24 hours (2.0 µg/kg/min). As reperfusion was successful following the aspiration thrombectomy, stenting during primary PCI was deferred. Following PCI, low-molecular-weight heparin (1 mg/kg body weight, twice daily) was administered during the period of index hospitalisation. Investigations did not reveal

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Section: A 2bmentioning

confidence: 94%

Double jeopardy in acute ST-segment elevation myocardial infarction

Ananthakrishna

Wang

Zhao

et al. 2017

smedj

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“…Accordingly, a systematic and comprehensive analysis of TB may take sense in the era of bioresorbable vascular scaffolds, as STEMI patients appear to represent an attractive target for the use of these novel devices [7]. Also, TB assessment may help to identify patients for alternative strategies such as "delayed stenting", given the conflicting results of its routine application [8].…”

Section: Introductionmentioning

confidence: 99%

Thrombus burden quantification: an evolving tool for coronary interventions

Sánchez¹,

Alfonso²

2017

Interventional-Cardiology

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“…However, since stent implantation may cause intraprocedural thrombotic complications (IPTEs), including distal embolization of thrombus leading to microvascular obstruction (MVO) and no-reflow (2,3) some clinicians have questioned whether immediate stent implantation is mandated in all patients, or instead, whether stent implantation could be deferred for a limited period to enable the beneficial effects of restored blood flow and medical therapy. With this in mind, a number of clinical investigations of deferred stenting (DS) strategies have been assessed (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). This was the focus of the Minimalist Immediate Mechanical Intervention (MIMI) trial (14).…”

mentioning

confidence: 99%

“…These are associated with a larger infarct size and an adverse prognosis (21). The hypothesis underpinning a DS approach is the potential to reduce coronary thrombus burden after initial stabilization of infarct related lesion and preserve microvascular function, therefore reducing the likelihood of slow and no reflow and MVO (14)(15)(16).…”

mentioning

confidence: 99%

“…Subsequently, the findings of the DEFER-STEMI trial were not substantiated in a larger open label, multi-centre clinical trial in Denmark. The Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI-3-DEFER) trial randomized 1,215 patients to immediate or delayed PCI at 48 hours (16). Routine DS implantation did not reduce the incidence of death, myocardial infarction, or repeat revascularization when compared with immediate stent implantation.…”

mentioning

confidence: 99%

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