16-year follow-up of the Danish Acute Myocardial Infarction 2 (DANAMI-2) trial: Primary percutaneous coronary intervention vs. fibrinolysis in ST-segment elevationmyocardial infarction
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16-year follow-up of the Danish Acute Myocardial Infarction 2 (DANAMI-2) trial : Primary percutaneous coronary intervention vs. fibrinolysis in ST-segment elevationmyocardial infarction. / Thrane, Pernille G.; Kristensen, Steen D.; Olesen, Kevin K.W.; Mortense, Leif S.; Bøtker, Hans Erik; Thuesen, Leif; Hansen, Henrik S.; Abildgaard, Ulrik; Engstrøm, Thomas; Andersen, Henning R.; Maeng, Michael.
I: European Heart Journal, Bind 41, Nr. 7, 2020, s. 847-854.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - 16-year follow-up of the Danish Acute Myocardial Infarction 2 (DANAMI-2) trial
T2 - Primary percutaneous coronary intervention vs. fibrinolysis in ST-segment elevationmyocardial infarction
AU - Thrane, Pernille G.
AU - Kristensen, Steen D.
AU - Olesen, Kevin K.W.
AU - Mortense, Leif S.
AU - Bøtker, Hans Erik
AU - Thuesen, Leif
AU - Hansen, Henrik S.
AU - Abildgaard, Ulrik
AU - Engstrøm, Thomas
AU - Andersen, Henning R.
AU - Maeng, Michael
PY - 2020
Y1 - 2020
N2 - Aims The DANish Acute Myocardial Infarction 2 (DANAMI-2) trial found that interhospital transport to primary percutaneous coronary intervention (pPCI) was superior to fibrinolysis at the local hospital in patients with ST-segment elevation myocardial infarction (STEMI) at 30 days. The present study investigates the 16-year cardiovascular outcomes. Methods and results We randomized 1572 STEMI patients to pPCI or fibrinolysis at 24 referral hospitals and 5 invasive centres in Denmark. Patients randomized to pPCI at referral hospitals were immediately transported to the nearest invasive centre. The main endpoint of the current study was a composite of death or rehospitalization for myocardial infarction (MI). Outcome information beyond 3 years was obtained through Danish health registries. After 16 years, pPCI-treated patients had a sustained lower rate of composite endpoint compared to patients treated with fibrinolysis in the overall cohort [58.7% vs. 62.3%; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76-0.98], and among patients transported for pPCI (58.7% vs. 64.1%; HR 0.82, 95% CI 0.71-0.96). No difference in all-cause mortality was found, but cardiac mortality was reduced by an absolute of 4.4% in favour of pPCI (18.3% vs. 22.7%; HR 0.78, 95% CI 0.63-0.98). pPCI postponed a main event with 12.3 months in average compared to fibrinolysis (95% CI 5.0-19.5). Conclusion The benefit of pPCI over fibrinolysis was maintained at 16-year follow-up. pPCI reduced the composite endpoint of death or rehospitalization for MI, reduced cardiac mortality, and delayed average time to a main event by approximately 1 year.
AB - Aims The DANish Acute Myocardial Infarction 2 (DANAMI-2) trial found that interhospital transport to primary percutaneous coronary intervention (pPCI) was superior to fibrinolysis at the local hospital in patients with ST-segment elevation myocardial infarction (STEMI) at 30 days. The present study investigates the 16-year cardiovascular outcomes. Methods and results We randomized 1572 STEMI patients to pPCI or fibrinolysis at 24 referral hospitals and 5 invasive centres in Denmark. Patients randomized to pPCI at referral hospitals were immediately transported to the nearest invasive centre. The main endpoint of the current study was a composite of death or rehospitalization for myocardial infarction (MI). Outcome information beyond 3 years was obtained through Danish health registries. After 16 years, pPCI-treated patients had a sustained lower rate of composite endpoint compared to patients treated with fibrinolysis in the overall cohort [58.7% vs. 62.3%; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76-0.98], and among patients transported for pPCI (58.7% vs. 64.1%; HR 0.82, 95% CI 0.71-0.96). No difference in all-cause mortality was found, but cardiac mortality was reduced by an absolute of 4.4% in favour of pPCI (18.3% vs. 22.7%; HR 0.78, 95% CI 0.63-0.98). pPCI postponed a main event with 12.3 months in average compared to fibrinolysis (95% CI 5.0-19.5). Conclusion The benefit of pPCI over fibrinolysis was maintained at 16-year follow-up. pPCI reduced the composite endpoint of death or rehospitalization for MI, reduced cardiac mortality, and delayed average time to a main event by approximately 1 year.
KW - Fibrinolysis
KW - Long-term outcome
KW - Percutaneous coronary intervention
KW - ST-elevation myocardial infarction
U2 - 10.1093/eurheartj/ehz595
DO - 10.1093/eurheartj/ehz595
M3 - Journal article
C2 - 31504424
AN - SCOPUS:85075210794
VL - 41
SP - 847
EP - 854
JO - European Heart Journal
JF - European Heart Journal
SN - 0195-668X
IS - 7
ER -
ID: 253187292