News | Cath Lab | April 18, 2016

Deferred Stenting Shows No Clinical Benefit for STEMI Patients

Largest trial to date contradicts findings of promising preliminary studies

STEMI, delayed or deferred stent implantation, DANAMI-3-DEFER trial, ACC.16

April 18, 2016 — Delayed or deferred stent implantation in patients showed no clinical benefit in patients experiencing the deadliest form of heart attack, ST-segment elevation myocardial infarction (STEMI), according to research presented at the American College of Cardiology’s 65th Annual Scientific Session (ACC.16). Researchers noted delayed or deferred implantation failed to reduce death from any cause, hospitalization for heart failure, subsequent heart attacks or the need for a repeat procedure to restore blood flow to the heart.

“The take-home message from this study is that deferred stent implantation cannot be recommended as a routine procedure for STEMI patients treated with primary percutaneous coronary intervention,” said Henning Kelbaek, M.D., of Roskilde Hospital, University of Copenhagen, Denmark, and lead author of the study. “Our results completely rebut the promising findings of preliminary studies that suggested deferred stenting should translate to clinical benefit.”

STEMI is a severe form of heart attack caused by prolonged blockage of blood supply in the heart. It requires immediate angioplasty, a non-surgical procedure in which a balloon is fed into the blood vessels through a catheter and inflated to open narrowed or blocked arteries, allowing blood to flow. A stent is usually placed at the blockage site to keep the artery open. In the United States, about 250,000 people experience a STEMI every year.

After the blocked artery is opened, the blockage site often contains residual blood clots that may, when the stent is implanted, be displaced downstream into the small branches of the artery. If this happens, it can damage heart muscle and block small blood vessels. Previous small studies suggested that delaying stent implantation for a period of time ranging from several hours to several days after reopening the artery might reduce the risk of blood-flow disturbance. The thinking was that medication given during the delay might allow the residual blood clots to diminish, reducing the risk of a displaced clot damaging the small branches of the artery. The DANAMI-3-DEFER trial was the largest trial yet conducted to evaluate whether delaying stent implantation would improve patients' survival and reduce their risk of heart failure or another heart attack.

In the trial, which took place in Denmark, 1,234 patients (average age 61; 75 percent male) with acute STEMI symptoms of less than 12 hours’ duration were randomly assigned to receive standard angioplasty with immediate stent implantation or angioplasty followed by stent implantation after a re-examination 24 to 48 hours later. After an average follow-up time of 43 months, 105 patients or 17 percent in the DEFER group and 109 or 18 percent in the standard treatment group met the primary endpoint, a composite of death from any cause, hospitalization for heart failure, a second heart attack and unplanned repeat angioplasty, a nonsignificant difference.

Although the trial was the largest so far to address the issue of delayed stent implantation, it may not have been large enough to detect a difference between the two treatment groups, Kelbaek said. Another limitation is that the trial did not select patients who were at the highest risk for developing another arterial blockage, such as those over age 65, those who have had more than one heart attack or those known to have a large number of blood clots.

“We cannot rule out that a fraction of our patients who met these criteria might have benefitted from delayed stent placement, especially because we found a small improvement in heart-muscle function 18 months after treatment among patients who underwent deferred stenting,” Kelbaek said.

The study was not powered to detect this improvement, but Kelbaek said he and his team would now look carefully for possible “hypothesis-generating” findings in subsets of patients –– both those who might have benefitted from the deferred-treatment strategy and, equally important, those in whom this strategy might have worsened their condition.

The DANAMI-3-DEFER trial was funded by the Danish Agency for Science, Technology and Innovation and Danish Council for Strategic Research.

This study was simultaneously published online in The Lancet at the time of presentation.

For more information:

Related Content

Drug Stops Dangerous Bleeding in Patients Taking Factor Xa Inhibitors


News | ACC | March 22, 2018
March 22, 2018 — The experimental drug...
Videos | ACC | March 21, 2018
DAIC Editor Dave Fornell takes a tour of some of the most interesting new technologies on the expo floor at
ACC 2018 Late-Breaking Trials Announced
News | ACC | March 21, 2018
Here is a list of the American College of Cardiology (ACC) 2018 annual meeting late-breaking clinical trials presente
Inhaled Therapy Ineffective in Difficult-to-Treat Heart Failure at ACC 2018.

Image from presentation, "Inorganic Nitrite Delivery to Improve Exercise Capacity in HFpEF: The INDIE-HFpEF Trial," Borlaug

News | ACC | March 20, 2018
March 20, 2018 — Four weeks of treatment with a novel inhaled medication failed to improve exercise capacity, daily a
Trial for Gout Drug Meets Primary Endpoint, Raises Safety Concerns, image shows a CT scan showing gout in the knees.
News | ACC | March 20, 2018
March 20, 2018 — Febuxostat, a gout dr...
More Deaths, Strokes Seen with Perioperative Beta Blocker One Year After Surgery

Image from presentation, "1-Year outcomes of perioperative beta-blockade in patients undergoing noncardiac surgery," Devereaux 

News | ACC | March 20, 2018
March 20, 2018 — During the 12 months after undergoing noncardiac surgery, patients with or at risk for heart disease
Canakinumab Doesn’t Prevent Prediabetes from Progressing to Diabetes according to a late-breaking study at ACC 2018.
News | ACC | March 20, 2018
March 20, 2018 — The anti-inflammatory...
Dabigatran Reduces Major Cardiovascular Complications in Patients With Myocardial Injury after Noncardiac Surgery
News | ACC | March 20, 2018
March 20, 2018 — Treatment with the blood-thinning drug dabigatran significantly reduced the risk of death, heart att
Statins May Bring Benefits at Time of Treatment for Heart Attack, Angina

Image from presentation, "Statins Evaluation in Coronary Procedures and Revascularization," Berwanger 

News | ACC | March 20, 2018
March 20, 2018 — Getting a large dose of a statin did not have an impact on major adverse cardiac events among a broa
Ticagrelor Has Comparable Safety to Clopidogrel after Heart Attack

Image from presentation, "Ticagrelor Versus Clopidogrel After Thrombolytic Therapy in Patients With St-Elevation Myocardial Infarction: A Randomized Clinical Trial," Berwanger 

News | ACC | March 20, 2018
March 20, 2018 — Among people younger than 75 years who were given clot busters to treat a heart attack, taking the m
Overlay Init