Long-term data confirm superiority of inter-hospital transport for primary PCI vs fibrinolysis

Patients with ST-segment elevation myocardial infarction (STEMI) who are transferred to the closest available invasive centre capable of primary percutaneous coronary intervention (pPCI), experience better outcomes than patients who are given fibrinolysis in their local facility. This was already demonstrated in 2003 and has been confirmed again in 2019.

The aim of the Danish DANAMI-2 study was to evaluate thrombolytic vs invasive therapy in patients with acute myocardial infarction (MI). Between 1997 and 2001, the study enrolled a total of 1,572 patients with acute MI. Of these patients, 1,129 were enrolled at 24 referral hospitals and 443 patients at 5 invasive-treatment centres. Patients were randomised to either reperfusion with pPCI therapy at an invasive centre or fibrinolytic treatment at the admission hospital. If patients randomised to pPCI were admitted to a referral hospital, they were immediately transported to an invasive centre (transfer time of 3 hours from randomisation until arrival at a cath lab). The primary study endpoint was a composite of death, clinical evidence of re-infarction, or disabling stroke at 30 days [1]. Sixteen years later, the 3-year follow-up data from the study were linked to these patients using an unique personal identification number. It was shown that 60.0% of patients experienced a composite endpoint of all-cause death, clinical re-infarction, or disabling stroke, and 50.8% of patients died. Primary PCI was associated with a 14% relative reduction in the original composite endpoint as mentioned above. Invasive pPCI further yielded a 25% reduction in re-infarction rates as well as a 22% reduction in cardiac deaths. It was concluded that pPCI remains the best way to treat STEMI patients, even after 16 years of follow-up, provided that transportation of patients can be achieved <2 hours [2].

1. Andersen HR, et al. NEJM 2003;349:733-742.
2. Thrane PG, et al. DANAMI-2 - 16-year follow-up of the Danish Acute Myocardial Infarction 2 trial - Primary percutaneous coronary intervention versus fibrinolysis in ST-elevation myocardial infarction. FP Number 4203. ESC Congress 2019, 31 Aug-4 Sept, Paris, France.

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Posted on 10 October, 2019