期刊
EUROPEAN HEART JOURNAL
卷 41, 期 7, 页码 847-854出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehz595
关键词
ST-elevation myocardial infarction; Long-term outcome; Fibrinolysis; Percutaneous coronary intervention
资金
- Novo Nordic Foundation [NNF14OC0008817]
- Cardiology Research Unit at Aarhus University Hospital, Denmark
- Danish Heart Foundation, Denmark
- Danish Medical Research Council, Denmark
- Bristol-Myers Squibb, Denmark
- Cordis, Denmark
- PharmaciaUpjohn, Denmark
- AstraZeneca, Denmark
- Pfizer, Denmark
- Boehringer Ingelheim, Denmark
- Guerbet, Denmark
- Novo Nordic Foundation
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.
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