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

被引:45
|
作者
Thrane, Pernille G. [1 ]
Kristensen, Steen D. [1 ]
Olesen, Kevin K. W. [1 ]
Mortensen, Leif S. [2 ]
Botker, Hans Erik [1 ]
Thuesen, Leif [3 ]
Hansen, Henrik S. [4 ]
Abildgaard, Ulrik [5 ]
Engstrom, Thomas [6 ]
Andersen, Henning R. [1 ]
Maeng, Michael [1 ]
机构
[1] Aarhus Univ Hosp, Dept Cardiol, Palle Juul Jensens Blvd 99, DK-8200 Aarhus N, Denmark
[2] Spange Stat, Elleparken 10, DK-8520 Lisbjerg, Denmark
[3] 9000 Aalborg Univ Hosp, Dept Cardiol, Hobrovej 18-20, Aalborg, Denmark
[4] Odense Univ Hosp, Dept Cardiol, JB Winslows Vej 4, DK-5000 Odense C, Denmark
[5] Copenhagen Univ Hosp Gentofte, Dept Cardiol, Gentofte Hosp Vej 1, DK-2900 Hellerup, Denmark
[6] Copenhagen Univ Hosp, Dept Cardiol, Blegdamsvej 9, DK-2100 Copenhagen O, Denmark
基金
英国医学研究理事会;
关键词
ST-elevation myocardial infarction; Long-term outcome; Fibrinolysis; Percutaneous coronary intervention; PRIMARY ANGIOPLASTY; IMMEDIATE THROMBOLYSIS; REPERFUSION THERAPY; REGISTRY; TRANSPORT; SYSTEM; PCI; ESC;
D O I
10.1093/eurheartj/ehz595
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:847 / 854
页数:8
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