Revascularization compared to medical treatment in patients with silent vs. symptomatic residual ischemia after thrombolyzed myocardial infarction--the DANAMI study.
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.
Madsen
Jan K
JK
Department of Cardiology and of Thoracic Surgery, Gentofte University Hospital, Hellerup, Denmark. jkmadsen@heart.dk
Nielsen
Torsten T
TT
Grande
Peer
P
Eriksen
Ulrik H
UH
Saunamäki
Kari
K
Thayssen
Per
P
Kassis
Eli
E
Rasmussen
Klaus
K
Haunsø
Stig
S
Haghfelt
Torben
T
Fritz-Hansen
Per
P
Hjelms
Erik
E
Paulsen
Peter K
PK
Alstrup
Poul
P
Arendrup
Henrik
H
Niebuhr-Jørgensen
Uffe
U
Andersen
Lars I
LI
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
D005343:Fibrinolytic Agents