My name is Jacob Lønborg. I'm an interventional cardiologist at Rigshospitalet, Copenhagen in Denmark, also associate professor and has been investigator in the DANAMI-3 trial.

What was the importance of this research?

So for this trial the most important thing was that we extended the follow-up until 10 years, and we have to consider that our patients, they live a long time with their stents and with the treatments. So we need to consider how they are doing in long term, and we do not have much data in general about long-term follow-up in our patients.

So the most important thing in this trial was that we extended the follow-up until 10 years. And we found that the concept of deferred stenting seemed to reduce the occurrence of hospitalisation for heart failure and was particularly efficiency in patients that presented with anterior STEMI, so there might be some patients that might benefit from this treatment.

Could you describe the study design and patient population in the DANAMI-3-DEFER trial?

This trial was a trial that was done 10 years ago or more than 10 years ago and it was in patients presenting with STEMI. And these patients were randomised to either immediate stent implantation, which is the control or conventional arm, or a deferred stenting strategy.

And deferred stenting was done by initial restoration of the blood flow in the infarcted artery, and then at a second stage procedure for 48 hours later, a stent was implanted. And the whole concept is that deferred stenting will reduce the occurrence of slow flow and also embolisation during the index procedure, and both of these phenomenons are related to adverse outcomes.

What were the key findings from the 10-year outcomes data?

This year at PCI I presented, on behalf of the DANAMI-3 trial investigators, the ten-years outcome. And what we found that there was no overall difference in terms of mortality or heart failure which was the primary endpoint.

However, there were a reduction in hospitalisation for heart failure. And we also saw that the patient that presented with an anterior STEMI, and these are the ones with a poor outcome, they might benefit from deferred stenting as we saw that the primary outcome was reduced with around 40% in this particular patient group.

What could be the impact of these findings on guidelines and future research?

For clinical practice, I do not think that deferred stenting should be a routine strategy. Now we have a large-scale, long-term follow-up showing no difference in the primary outcome. However, there are patients that will benefit from deferred stenting, and therefore, we should still consider using as the first stenting strategy in some patients that present with anterior STEMI, maybe long-symptom onset and also a high thrombus burden.

What further research is needed, and what are the next steps in optimizing reperfusion strategies?

This concept of deferred stenting has been tested in four trials and all of them are moderate or small size trials. So if we really want to have an answer of whether to use this strategy, we need a large-scale, multicentre, 4000-patient trial. But whether this will be done I'm not sure; it's a big hassle because the patients need two procedures and a lot of centres need to be involved — so whether it will be done I'm not sure.