September 7, 2026American Heart Journal
The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction: Ischemic postconditioning or deferred stent implantation versus conventional primary angioplasty and complete revascularization versus treatment of culprit lesion only
Key result
DANAMI 3 outlines trial designs evaluating ischemic postconditioning, deferred stenting, and complete revascularization in STEMI.
Why the study?
Clinical trial evidence was lacking for whether ischemic postconditioning or deferred stenting improves clinical outcomes, and whether complete or partial revascularization is preferred in STEMI patients with multivessel disease.
Do ischemic postconditioning, deferred stent implantation, or FFR-guided complete revascularization improve clinical outcomes in patients with STEMI undergoing primary PCI compared to conventional treatment?
Key Points
- To outline the design and clinical objectives of the DANAMI-3 trial evaluating three distinct interventional strategies in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
- Randomized trial program assessing three distinct interventional comparisons in patients undergoing primary percutaneous coronary intervention.
- Evaluates ischemic postconditioning versus conventional treatment, deferred stenting (1 to 3 days post-artery opening) versus conventional stenting, and culprit-only treatment versus fractional flow reserve-guided complete revascularization.
- Tracks clinical composite endpoints including all-cause mortality, hospitalization for heart failure, reinfarction, and repeat revascularization.
- Protocol establishes frameworks to determine whether reducing reperfusion injury or distal microvascular obstruction improves mortality and heart failure hospitalization rates.
- Comparative trial arms are structured to verify whether complete fractional flow reserve-guided revascularization provides superior long-term clinical benefit over culprit-lesion-only intervention.
Study Design
Type
RCT
Randomization
randomized
Structured PICO
Do ischemic postconditioning, deferred stent implantation, or FFR-guided complete revascularization improve clinical outcomes in patients with STEMI undergoing primary PCI compared to conventional treatment?
P
Population
Patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
I
Intervention
Three randomized strategies: (1) ischemic postconditioning, (2) deferring stent implantation in the infarct-related lesion 1 to 3 days after acute opening, and (3) fractional flow reserve (FFR)-guided complete revascularization in patients with multivessel disease.
C
Comparator
Conventional treatment (for postconditioning and deferred stenting trials) and treatment of the culprit lesion only (for the multivessel disease trial).
O
Outcome
Trial 1: Composite of death and hospitalization for heart failure. Trial 2: Composite of death, hospitalization for heart failure, reinfarction, and repeat revascularization. Trial 3: Composite of death, reinfarction, and repeat revascularization.composite
The DANAMI 3 trial program is designed to evaluate whether ischemic postconditioning, deferred stenting, or FFR-guided complete revascularization improve clinical outcomes in STEMI patients undergoing primary PCI.
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
GCGianluca CampoInterventional cardiologist, University Hospital of Ferrara
“The concern with not treating nonculprit lesions deemed physiologically insignificant at the time of primary PCI is that you have an adverse event after 3, 5, or 8 years.”
“There is a benefit with complete revascularization, and it is a durable benefit.”
“Abrupt reperfusion by angioplasty may itself damage the heart muscle. The thinking was that performing the reperfusion in a gentle, graded fashion would protect the heart against reperfusion injury.”
Implication
Does not support routine ischemic postconditioning or deferred stenting in STEMI; leaves open potential benefit in selected subgroups.
Cite This Study
Høfsten et al. (2015) conducted an RCT in ST-segment elevation myocardial infarction. Ischemic postconditioning, deferred stent implantation, and FFR-guided complete revascularization vs. Conventional treatment and culprit lesion only treatment was evaluated on Death and hospitalization for heart failure (trial 1); death, hospitalization for heart failure, reinfarction, and repeat revascularization (trial 2); death, reinfarction, and repeat revascularization (trial 3). The DANAMI 3 trial program was designed to evaluate ischemic postconditioning, deferred stenting, and complete revascularization in STEMI patients; no clinical results are reported.