16-year follow-up of the Danish Acute Myocardial Infarction 2 (DANAMI-2) trial: primary percutaneous coronary intervention vs. fibrinolysis in ST-segment elevation myocardial infarction

Pernille G Thrane, Steen D Kristensen, Kevin K W Olesen, Leif S Mortensen, Hans Erik Bøtker, Leif Thuesen, Henrik S Hansen, Ulrik Abildgaard, Thomas Engstrøm, Henning R Andersen, Michael Maeng

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

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.

Original languageEnglish
JournalEuropean Heart Journal
Volume41
Issue number7
Pages (from-to)847-854
ISSN0195-668X
DOIs
Publication statusPublished - 14 Feb 2020

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Fibrinolysis
Percutaneous Coronary Intervention
Myocardial Infarction
Confidence Intervals
Mortality
Referral and Consultation
ST Elevation Myocardial Infarction
Denmark
Registries
Health

Cite this

Thrane, Pernille G ; Kristensen, Steen D ; Olesen, Kevin K W ; Mortensen, Leif S ; Bøtker, Hans Erik ; Thuesen, Leif ; Hansen, Henrik S ; Abildgaard, Ulrik ; Engstrøm, Thomas ; Andersen, Henning R ; Maeng, Michael. / 16-year follow-up of the Danish Acute Myocardial Infarction 2 (DANAMI-2) trial : primary percutaneous coronary intervention vs. fibrinolysis in ST-segment elevation myocardial infarction. In: European Heart Journal. 2020 ; Vol. 41, No. 7. pp. 847-854.
@article{f833096641444d55b51c79553d3beb82,
title = "16-year follow-up of the Danish Acute Myocardial Infarction 2 (DANAMI-2) trial: primary percutaneous coronary intervention vs. fibrinolysis in ST-segment elevation myocardial infarction",
abstract = "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.",
author = "Thrane, {Pernille G} and Kristensen, {Steen D} and Olesen, {Kevin K W} and Mortensen, {Leif S} and B{\o}tker, {Hans Erik} and Leif Thuesen and Hansen, {Henrik S} and Ulrik Abildgaard and Thomas Engstr{\o}m and Andersen, {Henning R} and Michael Maeng",
note = "Published on behalf of the European Society of Cardiology. All rights reserved. {\circledC} The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.",
year = "2020",
month = "2",
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doi = "10.1093/eurheartj/ehz595",
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Thrane, PG, Kristensen, SD, Olesen, KKW, Mortensen, LS, Bøtker, HE, Thuesen, L, Hansen, HS, Abildgaard, U, Engstrøm, T, Andersen, HR & Maeng, M 2020, '16-year follow-up of the Danish Acute Myocardial Infarction 2 (DANAMI-2) trial: primary percutaneous coronary intervention vs. fibrinolysis in ST-segment elevation myocardial infarction', European Heart Journal, vol. 41, no. 7, pp. 847-854. https://doi.org/10.1093/eurheartj/ehz595

16-year follow-up of the Danish Acute Myocardial Infarction 2 (DANAMI-2) trial : primary percutaneous coronary intervention vs. fibrinolysis in ST-segment elevation myocardial infarction. / Thrane, Pernille G; Kristensen, Steen D; Olesen, Kevin K W; Mortensen, Leif S; Bøtker, Hans Erik; Thuesen, Leif; Hansen, Henrik S; Abildgaard, Ulrik; Engstrøm, Thomas; Andersen, Henning R; Maeng, Michael.

In: European Heart Journal, Vol. 41, No. 7, 14.02.2020, p. 847-854.

Research output: Contribution to journalJournal articleResearchpeer-review

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 elevation myocardial infarction

AU - Thrane, Pernille G

AU - Kristensen, Steen D

AU - Olesen, Kevin K W

AU - Mortensen, 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

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

PY - 2020/2/14

Y1 - 2020/2/14

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.

U2 - 10.1093/eurheartj/ehz595

DO - 10.1093/eurheartj/ehz595

M3 - Journal article

C2 - 31504424

VL - 41

SP - 847

EP - 854

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 7

ER -