2003Acute coronary syndromesIntervention1572 patients

DANAMI-2

Therapy group: Reperfusion strategy · Therapy: Primary angioplasty (including transfer) vs fibrinolysis

Primary angioplasty, even with rapid transfer to an interventional center, was superior to on-site fibrinolysis, mainly by reducing reinfarction.

Published in N Engl J Med (2003)

Question: Does primary angioplasty remain superior to fibrinolysis when a patient with ST-elevation myocardial infarction must be transferred from a community hospital to a center with invasive capability?
Design: Randomized trial of 1572 patients with acute myocardial infarction: 1129 enrolled at 24 referral hospitals (without angioplasty facilities) and 443 at 5 invasive-treatment centers.
Population: Patients with ST-elevation acute myocardial infarction admitted either to hospitals without interventional services or to centers with angioplasty available.
Intervention: Primary angioplasty, with transfer to an invasive center when the patient was at a referral hospital.
Control: On-site accelerated fibrinolysis with intravenous alteplase.
Primary outcome: Composite of death, clinical reinfarction, or disabling stroke at 30 days.
Results: At referral hospitals, the primary endpoint occurred in 8.5% with angioplasty vs. 14.2% with fibrinolysis (P=0.002); at invasive centers it was 6.7% vs. 12.3% (P=0.05). Overall, the benefit was driven mainly by fewer reinfarctions (1.6% vs. 6.3%; P<0.001), with no significant differences in death (6.6% vs. 7.8%; P=0.35) or stroke (1.1% vs. 2.0%; P=0.15).
Conclusion: A reperfusion strategy involving transfer for primary angioplasty is superior to on-site fibrinolysis, provided the transfer takes two hours or less.
Why it matters: It supported the development of regional MI care networks that transfer patients to catheterization-capable centers rather than treating them with fibrinolysis at hospitals without interventional services, as long as transfer is rapid.

Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.

Generated on October 18, 2026

Sources

Original publication on PubMed (PMID 12930925) ↗A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction.
Journal article (DOI) ↗

Videos explaining it

SEC takes you to ESC19 [IN] ∙ DANAMI 2 Trial

SEC · Sociedad Española de Cardiología ↗8:50Video page

Source: Sociedad Española de Cardiología · YouTube
Date: 3 Sept 2019
Audio: Spanish
Subtitles: MultilingualYouTube
Audio transl.: None

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Podcasts explaining it

Review of the DANAMI-2 trial
Cardiology Trials · Cardiology Trials ↗12 minEpisode page
Source
Cardiology Trials · Apple Podcasts
Date
23 Jan 2025
Audio
English
Translation
TextGoogle Chrome
Audio transl.
None

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