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

Title: 16-year follow-up of the Danish Acute Myocardial infarction 2 (DANAMI-2) trial – primary percutaneous coronary intervention versus fibrinolysis in ST-elevation myocardial infarction

Date: To be presented at ESC 2 September 2019 and published the same day in European Heart Journal.

Further information:

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
E-mail: michael.maeng@clin.au.dk
Fax: +45 78452117
Tel.: +45 26703237