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
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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DOI：
10.1093/eurheartj/ehm392
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发表时间：
2008-05-01
影响因子：
39.3
通讯作者：
Andersen, Henning R.
中科院分区：
文献类型：
--
作者：
Busk, Martin;Maeng, Michael;Andersen, Henning R.
DANAMI-2试验表明，在ST段抬高型心肌梗死（STEMI）患者中，在30天随访时，院间转移进行直接血管成形术的策略上级现场纤溶。本文报告了DAAMI-2中3年随访时预先规定的长期复合终点。方法和结果我们将1572例STEMI患者随机分为直接血管成形术组或静脉注射阿替普酶组; 1129例患者在24家转诊医院入组，443例患者在5家血管成形术中心入组。96%的血管成形术的医院间转移在2小时内完成。无患者失访。3年时，血管成形术与纤溶相比，复合终点（死亡、临床再梗死或致残性卒中）降低（19.6% vs. 25.2%，P =0.006）。对于转入血管成形术的患者，与接受现场纤溶的患者相比，复合终点发生率分别为20.1%和26.7%。（P = 0.007），死亡率分别为13.6%和16.4%（P = 0.18），临床再梗死发生率为8.9 vs. 12.3%（P = 0.05），和致残性卒中的比例分别为3.2%和4.7%结论基于复合终点的直接血管成形术转移的受益在3年后持续存在。对于具有DAAMI-2特征的患者，如果能够在2 h内完成院间转运，则应首选直接血管成形术。
Background The DANAMI-2 trial showed that in patients with ST-elevation myocardial infarction (STEMI), a strategy of inter-hospital transfer for primary angioplasty was superior to on-site fibrinolysis at 30 days follow-up. This paper reports on the pre-specified long-term composite endpoint at 3 years follow-up in DANAMI-2.Methods and results We randomized 1572 patients with STEMI to primary angioplasty or intravenous alteplase; 1129 patients were enrolled at 24 referral hospitals and 443 patients at 5 angioplasty centres. Ninety-six percent of inter-hospital transfers for angioplasty were completed within 2 h. No patients were lost to follow-up. The composite endpoint (death, clinical re-infarction, or disabling stroke) was reduced by angioplasty when compared with fibrinolysis at 3 years (19.6 vs. 25.2%, P =0.006). For patients transferred to angioplasty compared with those receiving on-site fibrinolysis, the composite endpoint occurred in 20.1 vs. 26.7% (P = 0.007), death in 13.6 vs. 16.4% (P = 0.18), clinical re-infarction in 8.9 vs. 12.3% (P = 0.05), and disabling stroke in 3.2 vs. 4.7% (P = 0.23).Conclusion The benefit of transfer for primary angioplasty based on the composite endpoint was sustained after 3 years. For patients with characteristics as those in DANAMI-2, primary angioplasty should be the preferred treatment strategy when inter-hospital transfer can be completed within 2 h.