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Randomized Controlled Trial
. 2025 Jun;18(6):e015369.
doi: 10.1161/CIRCINTERVENTIONS.125.015369. Epub 2025 May 20.

10-Year Outcomes of Deferred or Conventional Stent Implantation in Patients With STEMI (DANAMI-3-DEFER)

Jasmine Melissa Marquard  1 , Thomas Engstrøm  1   2 , Henning Kelbæk  3 , Rasmus Paulin Beske  1 , Utsho Islam  1 , Dan Eik Høfsten  1 , Lene Holmvang  1   2 , Frants Pedersen  1 , Christian Juhl Terkelsen  4 , Evald Høj Christiansen  4 , Hans-Henrik Tilsted  1 , Charlotte Glinge  1 , Reza Jabbari  1 , Ashkan Eftekhari  5 , Bent Raungaard  5 , Peter Clemmensen  3   6 , Hans Erik Bøtker  4 , Lisette Okkels Jensen  7 , Lars Køber  1   2 , Jacob Thomsen Lønborg  1   2
Affiliations
Randomized Controlled Trial

10-Year Outcomes of Deferred or Conventional Stent Implantation in Patients With STEMI (DANAMI-3-DEFER)

Jasmine Melissa Marquard et al. Circ Cardiovasc Interv. 2025 Jun.

Abstract

Background: Primary percutaneous coronary intervention (PCI) with stenting is recommended in ST-segment-elevation myocardial infarction. Immediate stenting may cause distal embolization, microvascular damage, and flow disturbances, leading to adverse outcomes. We report the 10-year clinical outcomes of deferred stenting versus conventional PCI in patients with ST-segment-elevation myocardial infarction.

Methods: We conducted a 10-year follow-up study of the open-label, randomized DANAMI-3-DEFER trial (Third Danish Study of Optimal Acute Treatment of Patients With STEMI - Deferred Stent Implantation Versus Conventional Treatment), conducted in 4 PCI centers in Denmark. Patients with ST-segment-elevation myocardial infarction and acute chest pain <12 hours were randomized to deferred stenting >24 hours after the index procedure or conventional PCI with immediate stenting. In the deferred group, immediate stable Thrombolysis in Myocardial Infarction flow II to III was established, and intravenous administration of either a glycoprotein IIb/IIIa antagonist or bivalirudin for >4 hours after the index procedure was recommended. The primary outcome was a composite of hospitalization for heart failure or all-cause mortality. Key secondary outcomes included individual components of the primary outcome and target vessel revascularization.

Results: Of 1215 patients, 603 were randomized to deferred stenting and 612 to conventional PCI. After 10 years, deferred stenting did not significantly reduce the primary composite outcome (hazard ratio, 0.82 [95% CI, 0.67-1.02]; P=0.08). In the deferred group, 124 (24%) died versus 150 (25%) in the conventional PCI group (hazard ratio, 0.95 [95% CI, 0.75-1.19]). Hospitalization for heart failure was lower in patients treated with deferred stenting compared with conventional PCI (odds ratio, 0.58 [95% CI, 0.39-0.88]). Target vessel revascularization was similar in both groups (odds ratio, 1.20 [95% CI, 0.81-1.79]).

Conclusions: Deferred stenting did not reduce all-cause mortality or the composite primary outcome after 10 years but reduced hospitalization for heart failure compared with conventional PCI.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01435408.

Keywords: heart failure; myocardial infarction; odds ratio; percutaneous coronary intervention; stents.

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Conflict of interest statement

Dr Køber: speaker’s honorarium from Astra Zeneca, Boehringer, Novartis, and Novo Nordisk. Dr Lønborg: an advisory board fee, an unrestricted grant, and speakers fee from Boston Scientific and speakers fee from Abbott, unrelated to this topic. Dr Engstrøm: advisory board fee from Abbott, Novo Nordisk and speakers fee from Novo Nordisk, Abbott, Boston Scientific. Dr Clemmensen: previous or current involvement in research contracts, consulting, speakers bureau or received research and educational grants from: Abbott, Abiomed, AliveCor, Inc, AstraZeneca, Aventis, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CeleCor, Daiichi Sankyo, Eli-Lilly, Evolva, Fibrex, Idorsia, IQVIA, Janssen, Merck, Myogen, Medtronic, Mitsubishi Pharma, The Medicines Company, Nycomed, Organon, Pfizer, Pharmacia, Philips, Regado, Sanofi, Searle, Servier, ViFor Pharma. VP, consultant fees, honoraria and educational grant from Abiomed J&JVP. Dr Jensen: unrestricted research grants to her institution from Biotronik, Biosensors and OrbusNeich. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Cumulative incidence of all-cause mortality or hospitalization for heart failure. Event rates of the primary outcome of all-cause mortality or hospitalization for heart failure. Follow-up was 10 years after primary percutaneous coronary intervention (PCI). HR indicates hazard ratio.
Figure 2.
Figure 2.
Cumulative incidence of all-cause mortality and hospitalization for heart failure. Event rates of (A) all-cause mortality and (B) hospitalization for heart failure. Follow-up was 10 years after primary percutaneous coronary intervention (PCI). HR indicates hazard ratio.
Figure 3.
Figure 3.
Subgroup analysis. The figure shows a forest plot of the primary outcome in subgroups. Hazard ratios with corresponding 95% CIs are shown and a P value for interaction. The widths of the CIs were not adjusted for multiplicity and should not be interpreted in terms of hypothesis testing. PCI indicates percutaneous coronary intervention; and TIMI, Thrombolysis in Myocardial Infarction.
See this image and copyright information in PMC

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