ESC Congress - News
The Danish multicenter randomised study of fibrinolytic therapy versus primary angioplasty in acute myocardial infarction (the DANAMI-2 trial). Outcome after three years follow-up.
Presenter report:
Nielsen, Torsten Toftegaard (Denmark)
Long-term randomized results on transfer for primary angioplasty (pPCI) versus on-site fibrinolysis for treatment of STEMI patients are sparse.The DANAMI-2 trial randomized 1572 STEMI patients to primary angioplasty (pPCI) or fibrinolysis (alteplase); 1129 of the patients were enrolled at 24 local hospitals without PCI facilities. Ninety-six percent of inter-hospital transfers for pPCI were completed within two hours. At 30 days, inter-hospital transfer for pPCI compared with fibrinolysis halved the primary composite endpoint of death, clinical reinfarction, or disabling stroke. The present study reports the long term (3 year) outcome. No patients were lost to follow-up.
The initial benefit of transfer for primary angioplasty based on the composite endpoint was sustained after three years (20.1 vs 26.7%, p=0.0007). Death occurred in 13.6 vs 16.4% (p=0.18), clinical reinfarction in 8.9% vs 12.3% (p=0.05), and disabling stroke in 3.2 vs 4.7% (p=0.23). Independent predictors of death were: clinical reinfarction, HR: 5.23 (3.63-7.54), anterior STEMI, HR.1.68 (1.26-2.23) and age, HR 1.08 (1.07-1.10).
We conclude that when inter-hospital transfer can be completed within two hours, primary angioplasty should be preferred over on-site fibrinolysis.
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