Primary percutaneous coronary intervention (PCI) with stent implantation is the recommended treatment for ST-segment elevation myocardial infarction (STEMI). However, immediate stent implantation can lead to distal embolization, microvascular damage, and impaired coronary flow, potentially resulting in adverse clinical outcomes. The aim of this study was to evaluate the 10-year clinical outcomes of deferred stent implantation versus conventional PCI in STEMI patients.
The primary endpoint (PEP) was a composite of all-cause mortality and heart failure (HF) hospitalization. The secondary endpoint (SEP) included the individual components of the PEP, cardiovascular mortality, recurrent myocardial infarction (MI), and target vessel revascularization.
Out of a total of 1215 patients, 603 were randomized to deferred stent implantation and 612 to conventional PCI. After 10 years of follow-up, deferred stent implantation did not entail a significant reduction in the PEP (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.67–1.02; p = 0.08). In the deferred group, 124 patients (24%) died compared to 150 patients (25%) in the conventional PCI group (HR: 0.95; 95% CI: 0.75–1.19). However, the HF hospitalization rate was significantly lower in the deferred group compared to the conventional group (odds ratio [OR]: 0.58; 95% CI: 0.39–0.88). The target vessel revascularization rate was similar between the two groups (OR: 1.20; 95% CI: 0.81–1.79).
Conclusion
The 10-year follow-up of the DANAMI-3-DEFER study showed that deferred stent implantation did not significantly reduce all-cause mortality or the composite primary endpoint, but it was associated with a lower rate of HF hospitalization compared to conventional PCI.
Reference: Jacob Thomsen Lønborg et al. at EuroPCR 2025.
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