16-year follow-up of the Danish Acute Myocardial Infarction 2 (DANAMI-2) trial: primary percutaneous coronary intervention vs. fibrinolysis in ST-segment elevation myocardial infarction.

Abstract

AIMS:

The DANish Acute Myocardial Infarction 2 (DANAMI-2) trial found that interhospital transport to primary percutaneous coronary intervention (pPCI) was superior to fibrinolysis at the local hospital in patients with ST-segment elevation myocardial infarction (STEMI) at 30 days. The present study investigates the 16-year cardiovascular outcomes.

METHODS AND RESULTS:

We randomized 1572 STEMI patients to pPCI or fibrinolysis at 24 referral hospitals and 5 invasive centres in Denmark. Patients randomized to pPCI at referral hospitals were immediately transported to the nearest invasive centre. The main endpoint of the current study was a composite of death or rehospitalization for myocardial infarction (MI). Outcome information beyond 3 years was obtained through Danish health registries. After 16 years, pPCI-treated patients had a sustained lower rate of composite endpoint compared to patients treated with fibrinolysis in the overall cohort [58.7% vs. 62.3%; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76-0.98], and among patients transported for pPCI (58.7% vs. 64.1%; HR 0.82, 95% CI 0.71-0.96). No difference in all-cause mortality was found, but cardiac mortality was reduced by an absolute of 4.4% in favour of pPCI (18.3% vs. 22.7%; HR 0.78, 95% CI 0.63-0.98). pPCI postponed a main event with 12.3 months in average compared to fibrinolysis (95% CI 5.0-19.5).

CONCLUSION:

The benefit of pPCI over fibrinolysis was maintained at 16-year follow-up. pPCI reduced the composite endpoint of death or rehospitalization for MI, reduced cardiac mortality, and delayed average time to a main event by approximately 1 year.

• Authors: Pernille G Thrane, Steen D Kristensen, Kevin K W Olesen, Leif S Mortensen, Hans Erik Bøtker, Leif Thuesen, Henrik S Hansen, Ulrik Abildgaard, Thomas Engstrøm, Henning R Andersen, Michael Maeng
• Journal: European heart journal (Eur Heart J) Vol. 41 Issue 7 Pg. 847-854 (02 14 2020) ISSN: 1522-9645 [Electronic] England
• PMID: 31504424 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: [email protected].

Chemical References

• Fibrinolytic Agents

Topics

• Denmark (epidemiology)
• Fibrinolysis
• Fibrinolytic Agents (therapeutic use)
• Follow-Up Studies
• Humans
• Myocardial Infarction (drug therapy)
• Percutaneous Coronary Intervention
• ST Elevation Myocardial Infarction (drug therapy, surgery)
• Treatment Outcome