Clinical outcomes of no stenting in patients with ST-segment elevation myocardial infarction undergoing deferred primary percutaneous coronary intervention
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Clinical outcomes of no stenting in patients with ST-segment elevation myocardial infarction undergoing deferred primary percutaneous coronary intervention. / Madsen, Jasmine Melissa; Kelbæk, Henning; Nepper-Christensen, Lars; Jacobsen, Mia Ravn; Ahtarovski, Kiril Aleksov; Høfsten, Dan Eik; Holmvang, Lene; Pedersen, Frants; Tilsted, Hans-Henrik; Aarøe, Jens; Jensen, Svend Eggert; Raungaard, Bent; Terkelsen, Christian Juhl; Køber, Lars; Engstrøm, Thomas; Lønborg, Jacob Thomsen.
I: EuroIntervention, Bind 18, Nr. 6, 2022, s. 482-491.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Clinical outcomes of no stenting in patients with ST-segment elevation myocardial infarction undergoing deferred primary percutaneous coronary intervention
AU - Madsen, Jasmine Melissa
AU - Kelbæk, Henning
AU - Nepper-Christensen, Lars
AU - Jacobsen, Mia Ravn
AU - Ahtarovski, Kiril Aleksov
AU - Høfsten, Dan Eik
AU - Holmvang, Lene
AU - Pedersen, Frants
AU - Tilsted, Hans-Henrik
AU - Aarøe, Jens
AU - Jensen, Svend Eggert
AU - Raungaard, Bent
AU - Terkelsen, Christian Juhl
AU - Køber, Lars
AU - Engstrøm, Thomas
AU - Lønborg, Jacob Thomsen
N1 - Publisher Copyright: © Europa Digital & Publishing 2022. All rights reserved.
PY - 2022
Y1 - 2022
N2 - Background: ST-segment elevation myocardial infarction (STEMI) is treated with stenting, but the underlying stenosis is often not severe, and stenting may potentially be omitted. Aims: The aim of the study was to investigate outcomes of patients with STEMI treated with percutaneous coronary intervention (PCI) without stenting. Methods: Patients were identified through the DANAMI-3-DEFER study. Stenting was omitted in the patients with stable flow after initial PCI and no significant residual stenosis on the deferral procedure, who were randomised to deferred stenting. These patients were compared to patients randomised to conventional PCI treated with immediate stenting. The primary endpoint was a composite of all-cause mortality, recurrent myocardial infarction (MI), and target vessel revascularisation (TVR). Results: Of 603 patients randomised to deferred stenting, 84 were treated without stenting, and in patients randomised to conventional PCI (n=612), 590 were treated with immediate stenting. Patients treated with no stenting had a median stenosis of 40%, median vessel diameter of 2.9 mm, and median lesion length of 11.4 mm. During a median follow-up of 3.4 years, the composite endpoint occurred in 14% and 16% in the no and immediate stenting groups, respectively (unadjusted hazard ratio [HR] 0.87, 95% confidence interval [CI]: 0.48-1.60; p=0.66). The association remained non-significant after adjusting for confounders (adjusted HR 0.53, 95% CI: 0.22-1.24; p=0.14). The rates of TVR and recurrent MI were 2% vs 4% (p=0.70) and 4% vs 6% (p=0.43), respectively. Conclusions: Patients with STEMI, with no significant residual stenosis and stable flow after initial PCI, treated without stenting, had comparable event rates to patients treated with immediate stenting.
AB - Background: ST-segment elevation myocardial infarction (STEMI) is treated with stenting, but the underlying stenosis is often not severe, and stenting may potentially be omitted. Aims: The aim of the study was to investigate outcomes of patients with STEMI treated with percutaneous coronary intervention (PCI) without stenting. Methods: Patients were identified through the DANAMI-3-DEFER study. Stenting was omitted in the patients with stable flow after initial PCI and no significant residual stenosis on the deferral procedure, who were randomised to deferred stenting. These patients were compared to patients randomised to conventional PCI treated with immediate stenting. The primary endpoint was a composite of all-cause mortality, recurrent myocardial infarction (MI), and target vessel revascularisation (TVR). Results: Of 603 patients randomised to deferred stenting, 84 were treated without stenting, and in patients randomised to conventional PCI (n=612), 590 were treated with immediate stenting. Patients treated with no stenting had a median stenosis of 40%, median vessel diameter of 2.9 mm, and median lesion length of 11.4 mm. During a median follow-up of 3.4 years, the composite endpoint occurred in 14% and 16% in the no and immediate stenting groups, respectively (unadjusted hazard ratio [HR] 0.87, 95% confidence interval [CI]: 0.48-1.60; p=0.66). The association remained non-significant after adjusting for confounders (adjusted HR 0.53, 95% CI: 0.22-1.24; p=0.14). The rates of TVR and recurrent MI were 2% vs 4% (p=0.70) and 4% vs 6% (p=0.43), respectively. Conclusions: Patients with STEMI, with no significant residual stenosis and stable flow after initial PCI, treated without stenting, had comparable event rates to patients treated with immediate stenting.
KW - plaque rupture
KW - risk stratification
KW - STEMI
U2 - 10.4244/EIJ-D-21-00950
DO - 10.4244/EIJ-D-21-00950
M3 - Journal article
C2 - 35289303
AN - SCOPUS:85134765835
VL - 18
SP - 482
EP - 491
JO - EuroIntervention
JF - EuroIntervention
SN - 1774-024X
IS - 6
ER -
ID: 327938461