Document Detail


Usefulness of quantitative baseline ST-segment elevation for predicting outcomes after primary coronary angioplasty or fibrinolysis (results from the DANAMI-2 trial).
MedLine Citation:
PMID:  16490423     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The DANAMI-2 trial showed a 40% decrease in the composite end point with primary coronary angioplasty versus fibrinolysis. This result was primarily driven by a decrease in reinfarction, with no significant difference in mortality or stroke rates. The objective of this study was to determine the prognostic value of the sum ST-segment elevation (SigmaST) on baseline electrocardiography in patients who were randomized to receive primary coronary angioplasty versus fibrinolysis. In the DANAMI-2, 1,450 patients had baseline ST-segment deviation measurements and were assigned to quartiles according to SigmaST: 0 to 6.5, 7.0 to 9.5, 10.0 to 14.5, and 15.0 to 70.5 mm. The composite and component end-point rates at 30 days were determined for each quartile and chi-square for trend statistic was used to compare end-point rates across quartiles of SigmaST. The composite end point occurred more often with increasing SigmaST (p = 0.05). With regard to component end points, only mortality increased significantly with SigmaST (p = 0.03), whereas reinfarction and stroke rates did not. By multivariate analysis, only SigmaST and age were independent predictors of mortality. The relative benefit of primary coronary angioplasty was similar for all SigmaST quartiles. In conclusion, the magnitude of SigmaST correlates with increased mortality at 30 days, thus driving the composite end point rate. Regardless of SigmaST, patients had a lower composite end-point rate with primary coronary angioplasty than with fibrinolysis.
Authors:
Maria Sejersten; Rasmus S Ripa; Charles Maynard; Galen S Wagner; Henning Rud Andersen; Peer Grande; Leif Spange Mortensen; Peter Clemmensen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-01-06
Journal Detail:
Title:  The American journal of cardiology     Volume:  97     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-02-21     Completed Date:  2006-04-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  611-6     Citation Subset:  AIM; IM    
Affiliation:
Heart Centre, Department of Cardiology, Rigshospitalet, University Hospital, Copenhagen, Denmark. m.sejersten@webspeed.dk
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Disease / drug therapy,  mortality,  physiopathology*,  therapy*
Electrocardiography
Female
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Heart Conduction System / physiopathology*
Humans
Male
Middle Aged
Myocardial Infarction / physiopathology,  therapy
Predictive Value of Tests
Prognosis
Randomized Controlled Trials as Topic
Stroke / etiology,  mortality
Survival Rate
Thrombolytic Therapy* / methods
Time Factors
Tissue Plasminogen Activator / therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator

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