title: Revascularization compared to medical treatment in patients with silent vs. symptomatic residual ischemia after thrombolyzed myocardial infarction--the DANAMI study.
abstract: OBJECTIVE
  The aim was to compare the effect of revascularization to conservative treatment in patients with residual silent and with residual symptomatic ischemia following acute myocardial infarction (AMI). The study was a subanalysis of the DANAMI (DANish AMI) randomized study of invasive vs. conservative treatment in patients with inducible ischemia after thrombolysis in AMI.
  
  
  RESULTS
  One thousand and eight patients were randomized to invasive or conservative treatment, stratified by the type of ischemia: silent, i.e. ST depression during an exercise test prior to discharge in 56%, or symptomatic, i.e. chest pain occurring either spontaneously during admission or during the exercise test, with or without ST changes, in 44%. Compared to a conservative strategy, invasive treatment reduced the incidence of nonfatal reinfarction, after in median 2.4 years, in both symptomatic patients (13.3-7.2%, p < 0.006) and patients with silent ischemia (10.1 vs. 5.7%, p < 0.05), and of admissions with unstable angina in symptomatic (44.5-27.6%, p < 0.0001) and silent ischemia (21.6-13.3%, p < 0.0006).
  
  
  CONCLUSIONS
  Compared to conservative strategy, invasive treatment reduces the risk of nonfatal reinfarction and hospital admissions for unstable angina in thrombolyzed post-AMI patients with silent as well as symptomatic exercise-induced ischemia.
authors.affiliation: Department of Cardiology and of Thoracic Surgery, Gentofte University Hospital, Hellerup, Denmark. jkmadsen@heart.dk
authors.forename: Jan K
authors.initials: JK
authors.lastname: Madsen
authors.forename: Torsten T
authors.initials: TT
authors.lastname: Nielsen
authors.forename: Peer
authors.initials: P
authors.lastname: Grande
authors.forename: Ulrik H
authors.initials: UH
authors.lastname: Eriksen
authors.forename: Kari
authors.initials: K
authors.lastname: Saunamäki
authors.forename: Per
authors.initials: P
authors.lastname: Thayssen
authors.forename: Eli
authors.initials: E
authors.lastname: Kassis
authors.forename: Klaus
authors.initials: K
authors.lastname: Rasmussen
authors.forename: Stig
authors.initials: S
authors.lastname: Haunsø
authors.forename: Torben
authors.initials: T
authors.lastname: Haghfelt
authors.forename: Per
authors.initials: P
authors.lastname: Fritz-Hansen
authors.forename: Erik
authors.initials: E
authors.lastname: Hjelms
authors.forename: Peter K
authors.initials: PK
authors.lastname: Paulsen
authors.forename: Poul
authors.initials: P
authors.lastname: Alstrup
authors.forename: Henrik
authors.initials: H
authors.lastname: Arendrup
authors.forename: Uffe
authors.initials: U
authors.lastname: Niebuhr-Jørgensen
authors.forename: Lars I
authors.initials: LI
authors.lastname: Andersen
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D009204:Myocardial Revascularization; D055502:Secondary Prevention
chemical_list: D005343:Fibrinolytic Agents