Danish Multicenter Randomized Study of Invasive Versus Conservative Treatment in Patients With Inducible Ischemia After Thrombolysis in Acute Myocardial Infarction (DANAMI)
- 5 August 1997
- journal article
- research article
- Published by Wolters Kluwer Health in Circulation
- Vol. 96 (3) , 748-755
- https://doi.org/10.1161/01.cir.96.3.748
Abstract
Background The aim of the DANish trial in Acute Myocardial Infarction (DANAMI) study was to compare an invasive strategy of percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) with a conservative strategy in patients with inducible myocardial ischemia who received thrombolytic treatment for a first acute myocardial infarction (AMI). Methods and Results Of the 503 patients randomized to an invasive strategy, PTCA was performed in 266 (52.9%) and CABG in 147 (29.2%) from 2 to 10 weeks after the AMI. Of the 505 patients in the conservative treatment group, only 8 (1.6%) had been revascularized 2 months after the AMI. The patients were followed up from 1 to 4.5 years. The primary end points were mortality, reinfarction, and admission with unstable angina. At 2.4 years’ follow-up (median), mortality was 3.6% in the invasive treatment group and 4.4% in the conservative treatment group (not significant). Invasive treatment was associated with a lower incidence of AMI (5.6% versus 10.5%; P =.0038) and a lower incidence of admission for unstable angina (17.9% versus 29.5%; P <.00001). The percentages of patients with a primary end point were 15.4% and 29.5% at 1 year, 23.5% and 36.6% at 2 years, and 31.7% versus 44.0% at 4 years ( P =<.00001) in the invasive and conservative treatment groups, respectively. At 12 months, stable angina pectoris was present in 21% of patients in the invasive treatment group and 43% in the conservative treatment group. Conclusions Invasive treatment in post-AMI patients with inducible ischemia results in a reduction in the incidence of reinfarction, fewer admissions due to unstable angina, and lower prevalence of stable angina. We conclude that patients with inducible ischemia before discharge who have received treatment with thrombolytic drugs for their first AMI should be referred to coronary arteriography and revascularized accordingly.Keywords
This publication has 21 references indexed in Scilit:
- Cardiologists' practices compared with practice guidelines: Use of beta-blockade after acute myocardial infarctionJournal of the American College of Cardiology, 1995
- Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patientsPublished by Elsevier ,1994
- Effect of verapamil on mortality and major events after acute myocardial infarction (The Danish Verapamil Infarction Trial II — DAVIT II)The American Journal of Cardiology, 1990
- Randomized controlled trial of late in-hospital angiography and angioplasty versus conservative management after treatment with recombinant tissue-type plasminogen activator in acute myocardial infarctionThe American Journal of Cardiology, 1990
- Comparison of Invasive and Conservative Strategies after Treatment with Intravenous Tissue Plasminogen Activator in Acute Myocardial InfarctionNew England Journal of Medicine, 1989
- Intravenous tissue plasminogen activator and size of infarct, left ventricular function, and survival in acute myocardial infarction.BMJ, 1988
- Twelve-Year Follow-up of Survival in the Randomized European Coronary Surgery StudyNew England Journal of Medicine, 1988
- THROMBOLYSIS WITH TISSUE PLASMINOGEN ACTIVATOR IN ACUTE MYOCARDIAL INFARCTION: NO ADDITIONAL BENEFIT FROM IMMEDIATE PERCUTANEOUS CORONARY ANGIOPLASTYThe Lancet, 1988
- Comparison of Coronary Artery Bypass Surgery and Medical Therapy in Patients 65 Years of Age or OlderNew England Journal of Medicine, 1985
- Evaluation of a QRS scoring system for estimating myocardial infarct size V. Specificity and method of application of the complete systemThe American Journal of Cardiology, 1985