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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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
,*
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
A complete list of the investigators in the DANAMI-2 trial appears in ref.3.