Does Delaying PCI in STEMI Heart Attack Improve Outcomes?

MedicalResearch.com Interview with:

Dr Henning Kelbæk MD Department of Cardiology Roskilde Hospital,Denmark

Dr. Henning Kelbæk

Dr Henning Kelbæk MD
Department of Cardiology
Roskilde Hospital,Denmark

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Kelbæk : In some patients with large acute myocardial infarcts, stent implantation has been connected with an increased risk of downstream embolization of thrombus material and disturbances in flow impairing the prognosis of the patients. In accordance, previous smaller studies have shown a benefit in angiographic and other parameters in patients having their stent implanted several hours after the artery was opened, allowing the infarct-related lesion to ’cool down’ and residual thrombus to dissolve under antithrombotic treatment, whereas larger randomised trials focusing on clinical data have been missing.

Our trial demonstrates, a bit surprisingly, that delaying or deferring stent implantation does not improve the clinical outcome of these patients. 

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Kelbæk : The take home message from our trial, is that if prehospital triage, medication and transportation of patients with STEMI is optimized, which is the case in a great part of Denmark, current practice of primary PCI has a high level of efficiency, and should not be changed. Still, we have to look further into subgroups in our trial that might benefit from deferred stenting, especially some of those with open arteries at arrival, and those with high residual thrombus burden, even after thrombectomy. 

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Kelbæk : Future research in this field of primary PCI should focus on selected high risk patients in a large randomized setting.

MedicalResearch.com: Is there anything else you would like to add?

Dr. Kelbæk : Our trial highlights the limitations encountered when findings from registries do not translate into clinical practice as assessed by randomised trials.

Citation:

Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): an open-label, randomised controlled trial

Kelbæk, Henning et al.

The Lancet , Volume 0 , Issue 0 ,
DOI: http://dx.doi.org/10.1016/S0140-6736(16)30072-1
Published Online:03 April 2016

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Dr Henning Kelbæk MD (2016). Does Delaying PCI in STEMI Heart Attack Improve Outcomes? MedicalResearch.com

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