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European Heart Journal Advance Access originally published online on October 23, 2007
European Heart Journal 2008 29(10):1259-1266; doi:10.1093/eurheartj/ehm392
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

The Danish multicentre randomized study of fibrinolytic therapy vs. primary angioplasty in acute myocardial infarction (the DANAMI-2 trial): outcome after 3 years follow-up

Martin Busk1, Michael Maeng1, Klaus Rasmussen2, Henning Kelbaek3, Per Thayssen4, Ulrik Abildgaard5, Else Vigholt6, Leif S. Mortensen7, Leif Thuesen1, Steen D. Kristensen1, Torsten T. Nielsen1, Henning R. Andersen for the DANAMI-2 Investigators1,{dagger},*

1 Department of Cardiology, Aarhus University Hospital Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark
2 Department of Cardiology, Aarhus University Hospital Aalborg, Aalborg, Denmark
3 The Heart Center, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
4 Department of Cardiology, Odense University Hospital, Odense, Denmark
5 Department of Cardiology, University Hospital Gentofte, Gentofte, Denmark
6 Department of Medicine, Horsens Hospital, Horsens, Denmark
7 UNI-C, Danish Information Technology Center for Education and Research, Aarhus, Denmark

Received 24 April 2007; revised 8 August 2007; accepted 23 August 2007; online publish-ahead-of-print 23 October 2007.

* Corresponding author. Tel: +45 89496111, Fax: +45 89496009. Email: henning.rud.andersen{at}dadlnet.dk

Background: The DANAMI-2 trial showed that in patients with ST-elevation myocardial infarction (STEMI), a strategy of inter-hospital transfer for primary angioplasty was superior to on-site fibrinolysis at 30 days follow-up. This paper reports on the pre-specified long-term composite endpoint at 3 years follow-up in DANAMI-2.

Methods and results: We randomized 1572 patients with STEMI to primary angioplasty or intravenous alteplase; 1129 patients were enrolled at 24 referral hospitals and 443 patients at 5 angioplasty centres. Ninety-six percent of inter-hospital transfers for angioplasty were completed within 2 h. No patients were lost to follow-up. The composite endpoint (death, clinical re-infarction, or disabling stroke) was reduced by angioplasty when compared with fibrinolysis at 3 years (19.6 vs. 25.2%, P =0.006). For patients transferred to angioplasty compared with those receiving on-site fibrinolysis, the composite endpoint occurred in 20.1 vs. 26.7% (P = 0.007), death in 13.6 vs. 16.4% (P = 0.18), clinical re-infarction in 8.9 vs. 12.3% (P = 0.05), and disabling stroke in 3.2 vs. 4.7% (P = 0.23).

Conclusion: The benefit of transfer for primary angioplasty based on the composite endpoint was sustained after 3 years. For patients with characteristics as those in DANAMI-2, primary angioplasty should be the preferred treatment strategy when inter-hospital transfer can be completed within 2 h.

Key Words: Acute myocardial infarction • Primary angioplasty • Fibrinolysis • Long-term outcome

{dagger} A complete list of the investigators in the DANAMI-2 trial appears in ref.3.


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