DANISH MULTICENTER RANDOMIZED STUDY OF INVASIVE VERSUS CONSERVATIVE TREATMENT IN PATIENTS WITH INDUCIBLE ISCHEMIA AFTER THROMBOLYSIS IN ACUTE MYOCARDIAL-INFARCTION (DANAMI)

Background The aim of the DANish trial in Acute Myocardial Infarction (DANAMI) study was to compare an invasive strategy of percutaneous tra nsluminal coronary angioplasty (PTCA) or coronary artery bypass grafti ng (CABG) with a conservative strategy in patients with inducible myoc ardial ischemia who received thrombolytic treatment for a first acute myocardial infarction (AMI). Methods and Results Of the 503 patients r andomized to an invasive strategy, PTCA was performed in 266 (52.9%) a nd CABG in 147 (29.2%) from 2 to 10 weeks after the AMI. Of the 505 pa tients in the conservative treatment group, only 8 (1.6%) had been rev ascularized 2 months after the AMI. The patients were followed up from 1 to 4.5 years. The primary end points were mortality, reinfarction, and admission with unstable angina. At 2.4 years' follow-up (median), mortality was 3.6% in the invasive treatment group and 4.4% in the con servative treatment group (not significant). Invasive treatment was as sociated with a lower incidence of AMI (5.6% versus 10.5%; P=.0038) an d a lower incidence of admission for unstable angina (17.9% versus 29. 5%; P<.00001). The percentages of patients with a primary end point we re 15.4% and 29.5% at 1 year, 23.5% and 36.6% at 2 years, and 31.7% ve rsus 44.0% at 4 years (P=<.00001) in the invasive and conservative tre atment groups, respectively. At 12 months, stable angina pectoris was present in 21% of patients in the invasive treatment group and 43% in the conservative treatment group. Conclusions Invasive treatment in po st-AMI patients with inducible ischemia results in a reduction in the incidence of reinfarction, fewer admissions due to unstable angina, an d lower prevalence of stable angina. We conclude that patients with in ducible ischemia before discharge who have received treatment with thr ombolytic drugs for their first AMI should be referred to coronary art eriography and revascularized accordingly.