Background: Primary percutaneous coronary intervention (PCI) is the standard treatment for ST-Elevation Myocardial Infarction (STEMI) patients. The DANAMI-3-DEFER study suggested that effective mechanical reperfusion without immediate stent placement can have outcomes comparable to conventional immediate stenting. This study investigates the efficacy of a tailored reperfusion strategy in STEMI patients, focusing on the reduced need for stent deployment in a subgroup managed with deferred intervention.

Methods and Results: In this prospective, single-center study from October 2019 to November 2021, 198 STEMI patients undergoing primary PCI were analyzed. Cardiologists chose between deferred strategy (DS) or conventional immediate stenting (CG) post successful reperfusion. The DS group, subjected to follow-up angiography for stenting decisions, inherently involved a higher use of thrombus aspiration (89.5% vs. 30.7% in CG) and GP IIb-IIIa inhibitors (31.6% vs. 6.7% in CG). Stent implantation in DS was notably lower (10.4% vs. 97.2% in CG). Survival analysis over a median follow-up of 741 days for DS and 561 days for CG revealed no significant differences in all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE).

Conclusions: The findings advocate for a tailored approach in STEMI management, emphasizing the potential of deferred and no-stent strategies. This approach could reduce the necessity for stent placement in certain patients, relying on individualized clinical assessment and advanced diagnostics. The results encourage further research integrating comprehensive physiological assessments and advanced imaging techniques to optimize patient selection and treatment outcomes.