Angiographic outcome in patients treated with deferred stenting after ST-segment elevation myocardial infarction-results from DANAMI-3-DEFER

Lars Nepper-Christensen; Henning Kelbæk; Kiril A Ahtarovski; Dan E Høfsten; Lene Holmvang; Frants Pedersen; Hans Henrik Tilsted; Jens Aarøe; Svend E Jensen; Bent Raungaard; Christian J Terkelsen; Lars Køber; Thomas Engstrøm; Jacob Lønborg

doi:10.1093/ehjacc/zuac098

Angiographic outcome in patients treated with deferred stenting after ST-segment elevation myocardial infarction-results from DANAMI-3-DEFER

Lars Nepper-Christensen, Henning Kelbæk, Kiril A Ahtarovski, Dan E Høfsten, Lene Holmvang, Frants Pedersen, Hans Henrik Tilsted, Jens Aarøe, Svend E Jensen, Bent Raungaard, Christian J Terkelsen, Lars Køber, Thomas Engstrøm, Jacob Lønborg

Institut for Klinisk Medicin - Hjertesygdomme

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

Aims Stent implantation during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) occasionally results in flow disturbances and distal embolization, which may cause adverse clinical outcomes. Deferred stent implantation seems to reduce the impairment on myocardial function, although the mechanisms have not been clarified. We sought to evaluate whether deferred stenting could reduce flow disturbance in patients treated with primary PCI.Methods and results Patients with STEMI included in the DANAMI-3-DEFER trial were randomized to deferred versus immediate stent implantation. The primary and secondary outcomes of this substudy were the incidences of slow/no reflow and distal embolization. A total of 1205 patients were included. Deferred stenting (n = 594) resulted in lower incidences of distal embolization [odds ratio (OR) 0.67, 95% confidence interval (CI) 0.46–0.98, P = 0.040] and slow/no reflow (OR 0.60, 95%CI 0.37–0.97, P = 0.039). In high-risk subgroups, the protective effect was greatest in patients >65 years of age (slow/no reflow: OR 0.36, 95% CI 0.17–0.72, P = 0.004 and distal embolization: OR 0.34, 95% CI 0.18–0.63, P = 0.001), in patients presenting with occluded culprit artery at admission (slow/no reflow: OR 0.33, 95% CI 0.16–0.65, P = 0.001 and distal embolization: OR 0.54, 95% CI 0.31–0.96, P = 0.036) and in patients with thrombus grade >3 (slow/no reflow: OR 0.37, 95% CI 0.20–0.67, P = 0.001 and distal embolization: OR 0.39, 95% CI 0.24–0.64, P < 0.001) with a significant P for interaction for all.Conclusion Deferred stent implantation reduces the incidences of slow/no reflow and distal embolization, especially in older patients and in those with total coronary occlusion or high level of thrombus burden.

Originalsprog	Engelsk
Tidsskrift	European Heart Journal: Acute Cardiovascular Care
Vol/bind	11
Nummer	10
Sider (fra-til)	742-748
Antal sider	7
ISSN	2048-8726
DOI	https://doi.org/10.1093/ehjacc/zuac098
Status	Udgivet - nov. 2022

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10.1093/ehjacc/zuac098

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Nepper-Christensen, L., Kelbæk, H., Ahtarovski, K. A., Høfsten, D. E., Holmvang, L., Pedersen, F., Tilsted, H. H., Aarøe, J., Jensen, S. E., Raungaard, B., Terkelsen, C. J., Køber, L., Engstrøm, T., & Lønborg, J. (2022). Angiographic outcome in patients treated with deferred stenting after ST-segment elevation myocardial infarction-results from DANAMI-3-DEFER. European Heart Journal: Acute Cardiovascular Care, 11(10), 742-748. https://doi.org/10.1093/ehjacc/zuac098

@article{a6b4e3911c084c18a8b38584cb3bbe9a,

title = "Angiographic outcome in patients treated with deferred stenting after ST-segment elevation myocardial infarction-results from DANAMI-3-DEFER",

abstract = "Aims Stent implantation during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) occasionally results in flow disturbances and distal embolization, which may cause adverse clinical outcomes. Deferred stent implantation seems to reduce the impairment on myocardial function, although the mechanisms have not been clarified. We sought to evaluate whether deferred stenting could reduce flow disturbance in patients treated with primary PCI.Methods and results Patients with STEMI included in the DANAMI-3-DEFER trial were randomized to deferred versus immediate stent implantation. The primary and secondary outcomes of this substudy were the incidences of slow/no reflow and distal embolization. A total of 1205 patients were included. Deferred stenting (n = 594) resulted in lower incidences of distal embolization [odds ratio (OR) 0.67, 95% confidence interval (CI) 0.46–0.98, P = 0.040] and slow/no reflow (OR 0.60, 95%CI 0.37–0.97, P = 0.039). In high-risk subgroups, the protective effect was greatest in patients >65 years of age (slow/no reflow: OR 0.36, 95% CI 0.17–0.72, P = 0.004 and distal embolization: OR 0.34, 95% CI 0.18–0.63, P = 0.001), in patients presenting with occluded culprit artery at admission (slow/no reflow: OR 0.33, 95% CI 0.16–0.65, P = 0.001 and distal embolization: OR 0.54, 95% CI 0.31–0.96, P = 0.036) and in patients with thrombus grade >3 (slow/no reflow: OR 0.37, 95% CI 0.20–0.67, P = 0.001 and distal embolization: OR 0.39, 95% CI 0.24–0.64, P < 0.001) with a significant P for interaction for all.Conclusion Deferred stent implantation reduces the incidences of slow/no reflow and distal embolization, especially in older patients and in those with total coronary occlusion or high level of thrombus burden.",

keywords = "Aged, Coronary Angiography/methods, Humans, Myocardium, Percutaneous Coronary Intervention/methods, ST Elevation Myocardial Infarction/diagnosis, Stents, Treatment Outcome",

author = "Lars Nepper-Christensen and Henning Kelb{\ae}k and Ahtarovski, {Kiril A} and H{\o}fsten, {Dan E} and Lene Holmvang and Frants Pedersen and Tilsted, {Hans Henrik} and Jens Aar{\o}e and Jensen, {Svend E} and Bent Raungaard and Terkelsen, {Christian J} and Lars K{\o}ber and Thomas Engstr{\o}m and Jacob L{\o}nborg",

note = "{\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: [email protected].",

year = "2022",

month = nov,

doi = "10.1093/ehjacc/zuac098",

language = "English",

volume = "11",

pages = "742--748",

journal = "European Heart Journal: Acute Cardiovascular Care",

issn = "2048-8726",

publisher = "SAGE Publications Ltd",

number = "10",

}

Nepper-Christensen, L, Kelbæk, H, Ahtarovski, KA, Høfsten, DE, Holmvang, L, Pedersen, F, Tilsted, HH, Aarøe, J, Jensen, SE, Raungaard, B, Terkelsen, CJ, Køber, L, Engstrøm, T & Lønborg, J 2022, 'Angiographic outcome in patients treated with deferred stenting after ST-segment elevation myocardial infarction-results from DANAMI-3-DEFER', European Heart Journal: Acute Cardiovascular Care, bind 11, nr. 10, s. 742-748. https://doi.org/10.1093/ehjacc/zuac098

Angiographic outcome in patients treated with deferred stenting after ST-segment elevation myocardial infarction-results from DANAMI-3-DEFER. / Nepper-Christensen, Lars; Kelbæk, Henning; Ahtarovski, Kiril A et al.
I: European Heart Journal: Acute Cardiovascular Care, Bind 11, Nr. 10, 11.2022, s. 742-748.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Angiographic outcome in patients treated with deferred stenting after ST-segment elevation myocardial infarction-results from DANAMI-3-DEFER

AU - Nepper-Christensen, Lars

AU - Kelbæk, Henning

AU - Ahtarovski, Kiril A

AU - Høfsten, Dan E

AU - Holmvang, Lene

AU - Pedersen, Frants

AU - Tilsted, Hans Henrik

AU - Aarøe, Jens

AU - Jensen, Svend E

AU - Raungaard, Bent

AU - Terkelsen, Christian J

AU - Køber, Lars

AU - Engstrøm, Thomas

AU - Lønborg, Jacob

PY - 2022/11

Y1 - 2022/11

N2 - Aims Stent implantation during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) occasionally results in flow disturbances and distal embolization, which may cause adverse clinical outcomes. Deferred stent implantation seems to reduce the impairment on myocardial function, although the mechanisms have not been clarified. We sought to evaluate whether deferred stenting could reduce flow disturbance in patients treated with primary PCI.Methods and results Patients with STEMI included in the DANAMI-3-DEFER trial were randomized to deferred versus immediate stent implantation. The primary and secondary outcomes of this substudy were the incidences of slow/no reflow and distal embolization. A total of 1205 patients were included. Deferred stenting (n = 594) resulted in lower incidences of distal embolization [odds ratio (OR) 0.67, 95% confidence interval (CI) 0.46–0.98, P = 0.040] and slow/no reflow (OR 0.60, 95%CI 0.37–0.97, P = 0.039). In high-risk subgroups, the protective effect was greatest in patients >65 years of age (slow/no reflow: OR 0.36, 95% CI 0.17–0.72, P = 0.004 and distal embolization: OR 0.34, 95% CI 0.18–0.63, P = 0.001), in patients presenting with occluded culprit artery at admission (slow/no reflow: OR 0.33, 95% CI 0.16–0.65, P = 0.001 and distal embolization: OR 0.54, 95% CI 0.31–0.96, P = 0.036) and in patients with thrombus grade >3 (slow/no reflow: OR 0.37, 95% CI 0.20–0.67, P = 0.001 and distal embolization: OR 0.39, 95% CI 0.24–0.64, P < 0.001) with a significant P for interaction for all.Conclusion Deferred stent implantation reduces the incidences of slow/no reflow and distal embolization, especially in older patients and in those with total coronary occlusion or high level of thrombus burden.

AB - Aims Stent implantation during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) occasionally results in flow disturbances and distal embolization, which may cause adverse clinical outcomes. Deferred stent implantation seems to reduce the impairment on myocardial function, although the mechanisms have not been clarified. We sought to evaluate whether deferred stenting could reduce flow disturbance in patients treated with primary PCI.Methods and results Patients with STEMI included in the DANAMI-3-DEFER trial were randomized to deferred versus immediate stent implantation. The primary and secondary outcomes of this substudy were the incidences of slow/no reflow and distal embolization. A total of 1205 patients were included. Deferred stenting (n = 594) resulted in lower incidences of distal embolization [odds ratio (OR) 0.67, 95% confidence interval (CI) 0.46–0.98, P = 0.040] and slow/no reflow (OR 0.60, 95%CI 0.37–0.97, P = 0.039). In high-risk subgroups, the protective effect was greatest in patients >65 years of age (slow/no reflow: OR 0.36, 95% CI 0.17–0.72, P = 0.004 and distal embolization: OR 0.34, 95% CI 0.18–0.63, P = 0.001), in patients presenting with occluded culprit artery at admission (slow/no reflow: OR 0.33, 95% CI 0.16–0.65, P = 0.001 and distal embolization: OR 0.54, 95% CI 0.31–0.96, P = 0.036) and in patients with thrombus grade >3 (slow/no reflow: OR 0.37, 95% CI 0.20–0.67, P = 0.001 and distal embolization: OR 0.39, 95% CI 0.24–0.64, P < 0.001) with a significant P for interaction for all.Conclusion Deferred stent implantation reduces the incidences of slow/no reflow and distal embolization, especially in older patients and in those with total coronary occlusion or high level of thrombus burden.

KW - Aged

KW - Coronary Angiography/methods

KW - Humans

KW - Myocardium

KW - Percutaneous Coronary Intervention/methods

KW - ST Elevation Myocardial Infarction/diagnosis

KW - Stents

KW - Treatment Outcome

UR - http://www.scopus.com/inward/record.url?scp=85161343691&partnerID=8YFLogxK

U2 - 10.1093/ehjacc/zuac098

DO - 10.1093/ehjacc/zuac098

M3 - Journal article

C2 - 36006808

SN - 2048-8726

VL - 11

SP - 742

EP - 748

JO - European Heart Journal: Acute Cardiovascular Care

JF - European Heart Journal: Acute Cardiovascular Care

IS - 10

ER -

Angiographic outcome in patients treated with deferred stenting after ST-segment elevation myocardial infarction-results from DANAMI-3-DEFER

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