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

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • Pernille G Thrane
  • ,
  • Steen D Kristensen
  • Kevin K W Olesen
  • Leif S Mortensen, Spange Statistics, Elleparken 10, 8520 Lisbjerg, Denmark.
  • ,
  • Hans Erik Bøtker
  • Leif Thuesen, Department of Cardiology, Aalborg University Hospital, Hobrovej 18, -9000, Aalborg, DK, Denmark. ksm.alzuhairi@gmail.com.
  • ,
  • Henrik S Hansen, Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, DK-5000 Odense C, Denmark.
  • ,
  • Ulrik Abildgaard, Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark.
  • ,
  • Thomas Engstrøm, Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, DK-2100 Copenhagen, Denmark. madsand@dadlnet.dk
  • ,
  • Henning R Andersen
  • Michael Maeng

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.

OriginalsprogEngelsk
TidsskriftEuropean Heart Journal
Vol/bind41
Nummer7
Sider (fra-til)847-854
Antal sider8
ISSN0195-668X
DOI
StatusUdgivet - 2020

Bibliografisk note

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

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