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.
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.


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).


CONCLUSIONS
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.
Busk
Martin
M
Department of Cardiology, Aarhus University Hospital Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark.
Maeng
Michael
M
Rasmussen
Klaus
K
Kelbaek
Henning
H
Thayssen
Per
P
Abildgaard
Ulrik
U
Vigholt
Else
E
Mortensen
Leif S
LS
Thuesen
Leif
L
Kristensen
Steen D
SD
Nielsen
Torsten T
TT
Andersen
Henning R
HR
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001241:Aspirin / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods / Q000451:nursing; D015912:Thrombolytic Therapy / Q000379:methods* / Q000451:nursing*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator; D001241:Aspirin