Elsevier

American Heart Journal

Volume 146, Issue 2, August 2003, Pages 234-241
American Heart Journal

Trial design
Danish multicenter randomized study on fibrinolytic therapy versus acute coronary angioplasty in acute myocardial infarction: rationale and design of the danish trial in acute myocardial infarction-2 (DANAMI-2)

https://doi.org/10.1016/S0002-8703(03)00316-8Get rights and content

Abstract

Background

Randomized trials have indicated that primary coronary angioplasty performed in patients admitted directly to highly-experienced angioplasty centers offers certain advantages over intravenous fibrinolytic therapy. However, the large majority of patients with acute myocardial infarction are submitted to hospitals without a catheterization laboratory. This means that additional transportation will be necessary for many patients if a strategy of acute coronary angioplasty is to be introduced as routine treatment. The delay of treatment caused by transportation might negate (part of) the benefits of primary angioplasty compared to fibrinolytic therapy given immediately at the local hospital.

Study design

The DANish trial in Acute Myocardial Infarction-2 (DANAMI-2) is the first large-scale study to clarify, in a whole community, which of the 2 treatment strategies is best. A total of 1900 patients with ST-elevation myocardial infarction are to be randomized: 800 patients will be admitted to invasive hospitals and 1100 patients will be admitted to referral hospitals. Half of the 1100 patients admitted to referral hospitals will immediately be transferred to an invasive center to be treated with primary angioplasty.

Implications

If acute transfer from a local hospital to an angioplasty center is the superior strategy, primary angioplasty should be offered to all patients as routine treatment on a community basis.

Section snippets

Overview

The planned randomization calls for a total of 1900 patients with suspected ST-elevation acute myocardial infarction to be randomly assigned to receive fibrinolytic therapy or primary angioplasty. The study will include 1100 patients admitted to referral hospitals and 800 patients admitted directly to invasive hospitals. Half of the 1100 patients will immediately be transferred by ambulance to an invasive hospital to be treated with primary angioplasty.

End points

The primary end point was a composite end

Conclusion

DANAMI-2 is a multicenter, randomized, community trial that enrolled 1572 patients with ST-elevation myocardial infarction to determine whether primary angioplasty or fibrinolysis should be the preferred treatment strategy on a community basis.

References (7)

There are more references available in the full text version of this article.

Cited by (101)

  • Achieving regionalization through rural interhospital transfer

    2015, American Journal of Emergency Medicine
    Citation Excerpt :

    Based partly on the effectiveness of developing robust trauma systems [24], STEMI care was regionalized into transfer networks locally to shorten the time to cardiac catheterization—another time-sensitive intervention. Mortality is reduced when percutaneous coronary intervention (PCI) is performed rapidly in STEMI patients [9,25–28], and guidelines recommend this therapy within 90 minutes of presentation [29,30]. In 2000, the Brain Attack Coalition published guidelines to establish Primary Stroke Centers to improve care of patients with acute ischemic stroke [31].

View all citing articles on Scopus

Supported by grants from the Danish Heart Foundation, The Danish Medical Research Council, Astra-Zeneca, Bristol-Myers Squibb, Cordis, a Johnson & Johnson Company, Pfizer, Pharmacia-Upjohn, Boehringer Ingelheim and Logic I/S Guerbet SA.

View full text