Danish multicenter randomized study on fibrinolytic therapy versus acute coronary angioplasty in acute myocardial infarction: rationale and design of the danish trial in acute myocardial infarction-2 (DANAMI-2)

Fibrinolysis for Acute Myocardial Infarction

“…In this trial, 1572 STEMI patients were randomized within 12 hours of symptom onset to a fibrinolytic versus a primary percutaneous coronary intervention (PCI) strategy in both community (nϭ1129) and primary PCI (nϭ443) hospitals. 19 This study integrated an interinstitutional transfer policy for those randomized to primary PCI if it could be achieved within 3 hours. The Data and Safety Monitoring Board prematurely terminated DANAMI 2 because of the perception of "clear benefit" of primary PCI.…”

Cardioprotective Pathways During Reperfusion: Focus on Redox Signaling and Other Modalities of Cell Signaling

“…Local and more widespread inflammatory responses will concur to increase the extent of infarction in otherwise viable tissue. This acceleration of damages after reperfusion led to the concept of myocardial reperfusion injury (3,21,68,109,156,177,202). , the signaling molecule synthesized from L-arginine by the nitric oxide synthases (NOSs, i.e., neuronal, endothelial, and inducible NOS).…”

Pharmacoinvasive Therapy

“…68 Interpretation of studies comparing fibrinolytic therapy with transfer for PCI is complicated because of selection of patients considered safe for transportation, the different fibrinolytics used in the medical treatment comparison arm, and the possibility that the fibrinolytic arm was handicapped by using doses of UFH that are now considered too high. 69,70 Also, the detection of recurrent MI is not easily accomplished within the first 24 hours after primary PCI because of elevation of biomarkers from the index event; for this reason, some studies have excluded periprocedural MI from the end point, potentially biasing the results toward primary PCI. 69 In DANAMI-2, episodes of recurrent ischemia and infarction in the fibrinolytic arm were treated with repeat fibrinolysis rather than referral for PCI, a treatment strategy that is different from one used in many other centers and that may have skewed the results in favor of primary PCI.…”

“…69,70 Also, the detection of recurrent MI is not easily accomplished within the first 24 hours after primary PCI because of elevation of biomarkers from the index event; for this reason, some studies have excluded periprocedural MI from the end point, potentially biasing the results toward primary PCI. 69 In DANAMI-2, episodes of recurrent ischemia and infarction in the fibrinolytic arm were treated with repeat fibrinolysis rather than referral for PCI, a treatment strategy that is different from one used in many other centers and that may have skewed the results in favor of primary PCI.…”