Key result
Invasive treatment reduced nonfatal reinfarction compared to conservative strategy in post-AMI patients with symptomatic (7.2% vs 13.3%, p<0.006) and silent ischemia (5.7% vs 10.1%, p<0.05).
Why the study?
Does invasive treatment reduce nonfatal reinfarction and hospital admissions for unstable angina in patients with inducible ischemia after thrombolyzed AMI compared to conservative treatment?
RCT (n=1,008)
Stratified by type of ischemia
Does invasive treatment reduce nonfatal reinfarction and hospital admissions for unstable angina in patients with inducible ischemia after thrombolyzed AMI compared to conservative treatment?
Absolute Event Rate: 7.2% vs 13.3%
p-value: p=< 0.006
Invasive treatment reduces the risk of nonfatal reinfarction and unstable angina admissions compared to conservative treatment in post-AMI patients with either silent or symptomatic ischemia after thrombolysis.
Supports invasive strategy in post-thrombolysis AMI with inducible ischemia; extends DANAMI findings to both symptomatic and silent subgroups.
AIMS: 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. METHODS AND 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.
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Madsen et al. (2006) conducted an RCT in Acute myocardial infarction (AMI) with inducible ischemia (n=1,008). Invasive treatment (revascularization) vs. Conservative treatment was evaluated on Nonfatal reinfarction (symptomatic ischemia subgroup) (p=< 0.006). Invasive treatment reduced nonfatal reinfarction compared to conservative strategy in post-AMI patients with symptomatic (7.2% vs 13.3%, p<0.006) and silent ischemia (5.7% vs 10.1%, p<0.05).
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