DANAMI 3: Deferred Stenting and Ischemic Postconditioning Have No Benefit in Primary PCI

Both ischemic postconditioning and deferred stenting showed no benefit in randomized studies conducted as part of the DANAMI 3 program.

Both the DANAMI 3-DEFER and the DANAMI 3-iPOSTshowed slight improvements in ventricular function after intervention, but clinical end points saw no change.

This does not mean that outcomes should be considered negative, only that the available treatments for infarction are near optimal, which is why it is rather difficult to show significant differences with any new intervention.

The DANAMI 3-DEFERwas conducted in 4 centers with onsite primary PCI capacity in Denmark, and included 1215 patients randomized to primary PCI vs. deferred stenting.

In the differed stenting group, a minimal mechanical intervention was used to reestablish flow in the culprit vessel and reassess with new catheterization at 48 hrs. 14% did not receive the stent vs. 1% in the conventional group.

Differed stenting did not reduce the primary end point rate (a composite of death from any cause, hospitalization for heart failure, a second heart attack, and unplanned repeat angioplasty in infarction culprit artery) at 42 month follow up (17% vs 18%; HR 0.99; CI 95% 0.76-1.29). Of the individual components, only unplanned repeat PCI was different between the groups, with a higher rate in those with differed stenting (7% vs 4%; HR 1.70; CI 95% 1.04-2.92).

The DANAM 3-iPOST tested the use of ischemic postconditioning that consisted of four 30-second occlusions with a balloon to try to ease reperfusion injury to the myocardium.

This study included 1234 patients randomized to conventional PCI vs. ischemic post conditioning. Ischemic postconditioning did not show benefits compared to conventional PCI(10.5% vs 11.2%; HR 0.93; CI 95% 0.66-1.30) and this was observed across all subgroups.