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.

Circulating miR-320a as a Predictive Biomarker for Left Ventricular Remodelling in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

“…In fact, despite the reestablishment of coronary artery perfusion, there is still an increasing incidence of LVAR in STEMI patients who underwent successful PPCI. In agreement with the literature [4,7], almost 22% of our STEMI patients developed LVAR as early as 6 months after PPCI. Classical cardiac markers, such as troponin-T and creatine kinase, were increased in all patients suffering from STEMI at admission, confirming the severity of the infarcts.…”

“…PPCI has substantially reduced mortality following STEMI by decreasing the infarct size and the extent of left ventricular adverse remodelling (LVAR) [2,3]. However, increasing evidence has demonstrated that despite successful and prompt revascularization,~25% of patients who survive STEMI develop heart failure (HF) as a consequence of LVAR [4][5][6][7]. STEMI treated with PPCI triggers a complex cascade of events associated with ischaemia and reperfusion (I/R), such as oxidative stress, neutrophil and platelet aggregation, and acute inflammatory responses [8] necessary to repair heart injuries.…”

2020 Korean Society of Myocardial Infarction Expert Consensus Document on Pharmacotherapy for Acute Myocardial Infarction

“…Primary PCI is preferred over fibrinolysis as a reperfusion therapy, because it is superior in terms of reducing death, reinfarction, and stroke if the delay in treatment is similar. 11) 12) 13) However, the advantages of primary PCI over fibrinolysis diminish in proportion to PCI-related time delays. ACC/AHA and ESC guidelines set time limits for action plans.…”

Peptide YY (PYY) Is Associated with Cardiovascular Risk in Patients with Acute Myocardial Infarction

“…Decision making and optimal timing for coronary intervention of NSTEMI patients are facilitated by different risk scores, including the Global Registry of Acute Coronary Events (GRACE) and the Thrombolysis in Myocardial Infarction (TIMI) risk score [2]. Coronary revascularization improves prognosis of patients with acute myocardial infarction [3]. However, a residual risk remains.…”