16 years after a myocardial infarction, balloon dilatation is still the superior treatment
At the European cardiology congress, Danish cardiologist researchers presented a 16-year follow-up study on the ground-breaking DANAMI-2 study. The follow-up shows that patients with a large myocardial infarction postpone the time to a new event or death with more than a year, if they undergo balloon dilatation instead of thrombolysis.
This Monday, researchers from Aarhus University Hospital and Aarhus University in Denmark presented the results of their follow-up study showing that balloon dilatation, also called primary percutaneous coronary intervention (PCI), is a superior treatment compared with thrombolysis in patients with a large myocardial infarction; this is even the case 16 years after the treatment was performed.
Patients undergoing PCI thus have a long-term reduced risk of a new myocardial event compared with patients receiving thrombolytic therapy.
Moreover, the study shows that patients with a heart-related mortality amount to 23% among patients receiving thrombolysis and only 18% among those undergoing PCI. It is the first time researchers can prove this effect of PCI compared to thrombolytic treatment in a single study.
The DANAMI-2 study
The Danish national DANAMI-2 study investigated if patients with a large myocardial infarction could achieve a better treatment result by being transported to a specialist cardiac centre compared with thrombolytic treatment at a local hospital. The DANAMI-2 study showed that significantly fewer patients experienced a new episode of myocardial infarction within the first 30 days if they were transported to a cardiac centre to undergo PCI. This ground-breaking result led to changes in the diagnostics, transport and treatment of myocardial infarction both in Denmark and internationally.
Treatment of myocardial infarction in Denmark is world-class
The DANAMI-2 study resulted in a revolution in the treatment of myocardial infarction. In Denmark, doctors/researchers developed methods to establish the diagnosis already in the patient's home or in the ambulance. This meant saving valuable time when the ambulance transported patients directly to the life-saving treatment at a heart centre. An American evaluation of the Danish treatment of myocardial infarction established that the Danish approach was among the best in the world.
16 years after DANAMI-2
The average age of patients in the DANAMI-2 was 63 years. A follow-up study conducted 16 years after the myocardial infarction provides a long-term perspective on the risk of dying or having a new myocardial infarction by comparing the two treatment strategies.
"The study shows that the benefit of PCI for patients with in a large myocardial infarction is more positive than expected. Even after 16 years, the effect of the two treatment strategies is not levelled out and we find a more frequent occurrence of new events of myocardial infarction and an increased heart-related death among patients treated with thrombolysis as opposed to patients undergoing PCI", says Michael Mæng, consultant cardiologist at Aarhus University Hospital.
"Several countries still have a poor organisation of transport and treatment in patients with myocardial infarction. Our results underline that countries and regions with possible access to a heart centre performing PCI within a two-hour timeframe should implement a strategy to transport patients with a large myocardial infarction to undergo PCI treatment".
Behind the research result:
Study type: Register-based follow-up of randomised controlled study (DANAMI-2)
Collaborators: Professor Henning Rud Andersen was the principal investigator of the original DANAMI-2 study. Medical student Pernille Gro Thrane was a research year student and responsible for writing the article in collaboration with the other authors. Professor Steen Dalby Kristensen and MD Kevin Kris Warnakula Olesen were co-supervisors on the research year project.
External financing: The Novo Nordisk foundation financed a scholarship to medical and research year student Pernille Gro Thrane.
Conflicts of interest: None.
Read the scientific article:
Authors: Pernille G Thrane BSca, Steen D Kristensen MD, DMScia, Kevin K W Olesen MDa, Leif S Mortensen MScb, Hans Erik Bøtker MD, DMScia, Leif Thuesen MD, DMScic, Henrik S Hansend MD DMSci, Ulrik Abildgaard MD, DMScie, Thomas Engstrøm MD, DMScif,, Henning R Andersen MD, DMScia, Michael Maeng MD, PhDa
a: Department of Cardiology, Aarhus University Hospital
b: Spange Statistics, Aarhus
c: Department of Cardiology, Aalborg University Hospital
d: Department of Cardiology, Odense University Hospital
e: Department of Cardiology, Copenhagen University Hospital Gentofte
f: Department of Cardiology, Rigshospitalet
Date: To be presented at ESC 2 September 2019 and published the same day in European Heart Journal.
Michael Mæng, MD, Consultant cardiologist, Associate professor
Department of Cardiology, Aarhus University Hospital
Department of Clinical Medicine, Aarhus University
Palle Juul-Jensens Boulevard 99
8200 Aarhus N, Denmark
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Tel.: +45 26703237