1. Revascularization compared to medical treatment in patients with silent vs. symptomatic residual ischemia after thrombolyzed myocardial infarction:the DANAMI study
- Author
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Madsen, Jan K, Nielsen, Torsten T, Grande, Peer, Eriksen, Ulrik H, Saunamäki, Kari, Thayssen, Per, Kassis, Eli, Rasmussen, Klaus, Haunsø, Stig, Haghfelt, Torben, Fritz-Hansen, Per, Hjelms, Erik, Paulsen, Peter K, Alstrup, Poul, Arendrup, Henrik, Niebuhr-Jørgensen, Uffe, Andersen, Lars I, and Study Group, DANAMI
- Subjects
Male ,medicine.medical_specialty ,Myocardial ischemia ,medicine.medical_treatment ,Ischemia ,Myocardial Infarction ,Myocardial Ischemia ,Revascularization ,Fibrinolytic Agents ,Recurrence ,Internal medicine ,Secondary Prevention ,medicine ,Myocardial Revascularization ,Humans ,Pharmacology (medical) ,In patient ,Myocardial infarction ,cardiovascular diseases ,Angina, Unstable ,Aged ,Medical treatment ,business.industry ,Middle Aged ,medicine.disease ,Conservative treatment ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Fibrinolytic agent - Abstract
Aims: The aim was to compare the effect of revascularization to conservative treatment in patients with residual silent and with residual symptomatic ischemia following acute myocardial infarction (AMI). The study was a subanalysis of the DANAMI (DANish AMI) randomized study of invasive vs. conservative treatment in patients with inducible ischemia after thrombolysis in AMI. Methods and Results: One thousand and eight patients were randomized to invasive or conservative treatment, stratified by the type of ischemia: silent, i.e. ST depression during an exercise test prior to discharge in 56%, or symptomatic, i.e. chest pain occurring either spontaneously during admission or during the exercise test, with or without ST changes, in 44%. Compared to a conservative strategy, invasive treatment reduced the incidence of nonfatal reinfarction, after in median 2.4 years, in both symptomatic patients (13.3–7.2%, p < 0.006) and patients with silent ischemia (10.1 vs. 5.7%, p < 0.05), and of admissions with unstable angina in symptomatic (44.5–27.6%, p < 0.0001) and silent ischemia (21.6–13.3%, p < 0.0006). Conclusions:Compared to conservative strategy, invasive treatment reduces the risk of nonfatal reinfarction and hospital admissions for unstable angina in thrombolyzed post-AMI patients with silent as well as symptomatic exercise-induced ischemia.
- Published
- 2007