Revascularization Compared to Medical Treatment in Patients with Silent vs. Symptomatic Residual Ischemia after Thrombolyzed Myocardial Infarction – The DANAMI Study

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.

2013 Esc Guidelines on the Management of Stable Coronary Artery Disease

“…Через 2,5 года наблюдения стратегия инвазивного лечения ассоциировалась со снижением частоты воз-никновения повторного инфаркта и менее частой стенокардией. Эти результаты были получены у паци-ентов как с симптоматической, так и с бессимптом-ной ишемией [433].…”

A Meta-Analysis of 17 Randomized Trials of a Percutaneous Coronary Intervention-Based Strategy in Patients With Stable Coronary Artery Disease

“…However, all but 1 trial (23) had included patients with previous myocardial infarction in a proportion ranging from 25% to 100%. In 4 of the 5 trials that included only patients with previous myocardial infarction (16,24,25,32), myocardial infarction was recent (Ͻ4 weeks) according to current guidelines (43). In the remaining trial (18), the time interval from myocardial infarction was on average Ͼ8 weeks.…”

Acute Coronary Syndromes: Diagnosis and Management, Part II

“…92 Similarly, a benefit of revascularization was found for patients with ischemia demonstrated by stress testing after thrombolytic therapy for STEMI. 93 Angiography provides detailed structural information that helps in determining prognosis and directing further revascularization plans (either PCI or CABG); when combined with LV angiography, it allows an assessment of global and regional LV function.…”