Primary PCI advantage over fibrinolysis persists long-term in DANAMI-2
MedWire News: Long-term follow-up of the Danish Acute Myocardial Infarction (DANAMI)-2 study indicates that the advantage of primary percutaneous coronary intervention (PCI) over fibrinolysis seen early on in the trial persists in the long term.
The study compared onsite fibrinolysis with primary PCI in 1572 patients with ST-segment elevation myocardial infarction (STEMI), the majority (n=1129) of whom were admitted at hospitals without primary PCI facilities (“referral hospitals”) and thus required transport for PCI.
As reported at the time by MedWire News, the 30-day follow-up results demonstrated that primary PCI was superior to fibrinolysis despite the transport-related treatment delay, findings that persisted at a 3-year follow-up.
Michael Maeng (Aarhus University Hospital, Denmark) and colleagues now report that the 8-year cumulative incidence of the primary endpoint of death or reinfarction was 34.8% among patients randomly assigned to undergo primary PCI compared with 41.3% in those assigned to fibrinolysis (p=0.003; hazard ratio [HR]=0.78).
This was mainly driven by the significant reduction in reinfarction in the primary PCI group (11.7% vs 18.5%, p<0.001; HR=0.60); the absolute reduction in death was a nonsignificant 3.5%.
Substudy findings demonstrated that patients randomized at referral hospitals also had significantly reduced rates of reinfarction (13.0% vs 18.5%, p=0.006; HR=0.66) and mortality (26.7% vs 33.3%, p=0.03; HR=0.78).
In the smaller invasive hospital substudy, which the authors emphasize was terminated when only half the planned number of patients had been enrolled, reinfarction was also significantly reduced (8.4% vs 18.6%, p=0.002; HR=0.43).
“This result reinforces that primary PCI should be offered to STEMI patients when interhospital transport to an invasive hospital can be completed within 120 minutes,” the team concludes in the journal Circulation.
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By Caroline Price