Timing, causes, and predictors of death after three years' follow-up in the Danish Multicenter Randomized Study of Fibrinolysis versus Primary Angioplasty in Acute Myocardial Infarction (DANAMI-2) trial.
This study evaluated the timing, causes, and predictors of death during long-term follow-up after primary angioplasty with stent implantation versus in-hospital fibrinolysis with a tissue plasminogen activator (alteplase). We randomized 1,572 patients with ST-elevation myocardial infarction to primary angioplasty or alteplase and followed them for 3 years. The causes of death were prospectively assessed by an end point committee unaware of the study treatment. A total of 225 patients (14.3%) died, 113 within the first 30 days and 112 between 31 days and 3 years. The mortality and causes of death did not differ between the 2 treatments. The causes of death were cardiogenic shock/congestive heart failure (41%), sudden death (17%), other cardiac death (10%), cancer (12%), and other noncardiac death (20%). Cardiac death was predominant during the first month only (86% of early deaths), and noncardiac death and cardiac death were equally frequent after 30 days (49% and 51% of late deaths, respectively). Independent predictors of death after discharge were age, left ventricular ejection fraction, diabetes, Killip class, and a lack of treatment with a beta blocker or statin. In conclusion, the causes of death did not differ between alteplase treatment and primary angioplasty with stent implantation. One half of the deaths within 3 years after ST-elevation myocardial infarction occurred during the first 30 days, and cardiac death was predominant during the first 30 days only.
Busk
Martin
M
Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
Maeng
Michael
M
Kristensen
Steen D
SD
Thuesen
Leif
L
Krusell
Lars R
LR
Mortensen
Leif S
LS
Steinmetz
Ebbe R
ER
Nielsen
Torsten T
TT
Andersen
Henning R
HR
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000800:Angioplasty, Balloon / Q000706:statistics & numerical data*; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D016001:Confidence Intervals; D003718:Denmark; D054855:Drug-Eluting Stents; D005080:Exercise Test; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016277:Ventricular Function, Left
D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D010959:Tissue Plasminogen Activator; D001241:Aspirin