Document Detail


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.
MedLine Citation:
PMID:  17956874     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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. METHODS AND 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). CONCLUSION: 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.
Authors:
Martin Busk; Michael Maeng; Klaus Rasmussen; Henning Kelbaek; Per Thayssen; Ulrik Abildgaard; Else Vigholt; Leif S Mortensen; Leif Thuesen; Steen D Kristensen; Torsten T Nielsen; Henning R Andersen;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-10-23
Journal Detail:
Title:  European heart journal     Volume:  29     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-15     Completed Date:  2008-07-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1259-66     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Aarhus University Hospital Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use
Aged
Angioplasty, Transluminal, Percutaneous Coronary / methods*
Aspirin / therapeutic use
Female
Fibrinolytic Agents / therapeutic use
Follow-Up Studies
Heparin / therapeutic use
Humans
Male
Middle Aged
Myocardial Infarction / therapy*
Myocardial Revascularization / methods,  nursing
Thrombolytic Therapy / methods*,  nursing*
Tissue Plasminogen Activator / therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Fibrinolytic Agents; 50-78-2/Aspirin; 9005-49-6/Heparin; EC 3.4.21.68/Tissue Plasminogen Activator
Investigator
Investigator/Affiliation:
H R Andersen / ; T T Nielsen / ; K Rasmussen / ; L Thuesen / ; H Kelbaek / ; P Thayssen / ; U Abildgaard / ; F Pedersen / ; J K Madsen / ; P Grande / ; A B Villadsen / ; L R Krusell / ; T Haghfelt / ; P Lomholt / ; S E Husted / ; E Vigholt / ; H K Kjaergard / ; L S Mortensen /

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