What question did this study set out to answer?

October 23, 2007European Heart JournalOpen Access

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

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Why the study?

Does primary angioplasty reduce the composite of death, clinical re-infarction, or disabling stroke compared to intravenous alteplase in patients with STEMI?

Population

1,572 patients with ST-elevation myocardial infarction enrolled at 24 referral hospitals and 5 angioplasty…

Comparison

Primary angioplasty vs Intravenous alteplase (on-site fibrinolysis)

Design

RCT, randomized

Follow-up

3 years

Authors

MBMartin BuskInterventional Cardiology MMMichael MængInterventional Cardiology KRKlaus RasmussenStatistics Denmark

Discussion

Member takes

Implication

Primary angioplasty reduces long-term events in STEMI; reinforces preference over fibrinolysis even with transfer delays.

Key Points

To assess the pre-specified long-term composite endpoint of death, clinical re-infarction, or disabling stroke at 3 years follow-up in patients randomized to primary angioplasty versus fibrinolysis.
Multicentre randomized trial enrolling 1572 patients with STEMI across Denmark (1129 patients at 24 referral hospitals and 443 at 5 angioplasty centres) assigned to primary angioplasty or intravenous alteplase.
Ninety-six percent of inter-hospital transfers for angioplasty were accomplished within 2 hours, with 0% loss to follow-up at 3 years.
Primary angioplasty significantly reduced the composite endpoint compared with fibrinolysis at 3 years across the entire cohort (19.6% vs. 25.2%, P=0.006).
For patients transferred for angioplasty compared to on-site fibrinolysis, the composite endpoint occurred in 20.1% versus 26.7% (P=0.007), largely driven by a reduction in clinical re-infarction (8.9% vs. 12.3%, P=0.05).
Transfer for primary angioplasty did not demonstrate a statistically significant reduction in 3-year mortality (13.6% vs. 16.4%, P=0.18) or disabling stroke (3.2% vs. 4.7%, P=0.23) compared to on-site fibrinolysis.

Structured PICO

Does primary angioplasty reduce the composite of death, clinical re-infarction, or disabling stroke compared to intravenous alteplase in patients with STEMI?

Population

1,572 patients with ST-elevation myocardial infarction (STEMI) enrolled at 24 referral hospitals and 5 angioplasty centres in Denmark

Intervention

Primary angioplasty (including inter-hospital transfer within 2 hours for patients at referral hospitals)

Comparator

Intravenous alteplase (on-site fibrinolysis)

Outcome

Composite of death, clinical re-infarction, or disabling stroke at 3 years follow-upcomposite

Primary angioplasty, even when requiring inter-hospital transfer within 2 hours, provides sustained long-term clinical benefits over fibrinolysis in STEMI patients at 3 years.

Cite This Study

Busk et al. (2007) studied this question.

synapsesocial.com/papers/6a7df3779c5f03601cb875e4 https://doi.org/10.1093/eurheartj/ehm392

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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

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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