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Heart. 2007 Dec;93(12):1552-5. Epub 2007 Jun 25.

Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events.

Author information

1
VA Health Services Research & Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, USA.

Abstract

OBJECTIVE:

Treatment delays may result in different clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who receive fibrinolytic therapy vs primary percutaneous coronary intervention (PCI). The aim of this analysis was to examine how treatment delays relate to 6-month mortality in reperfusion-treated patients enrolled in the Global Registry of Acute Coronary Events (GRACE).

DESIGN:

Prospective, observational cohort study.

SETTING:

106 hospitals in 14 countries.

PATIENTS:

3959 patients who presented with STEMI within 6 h of symptom onset and received reperfusion with either a fibrin-specific fibrinolytic drug or primary PCI.

MAIN OUTCOME MEASURES:

6-month mortality.

METHODS:

Multivariable logistic regression was used to assess the relationship between outcomes and treatment delay separately in each cohort, with time modelled with a quadratic term after adjusting for covariates from the GRACE risk score.

RESULTS:

A total of 1786 (45.1%) patients received fibrinolytic therapy, and 2173 (54.9%) underwent primary PCI. After multivariable adjustment, longer treatment delays were associated with a higher 6-month mortality in both fibrinolytic therapy and primary PCI patients (p<0.001 for both cohorts). For patients who received fibrinolytic therapy, 6-month mortality increased by 0.30% per 10-min delay in door-to-needle time between 30 and 60 min compared with 0.18% per 10-min delay in door-to-balloon time between 90 and 150 min for patients undergoing primary PCI.

CONCLUSIONS:

Treatment delays in reperfusion therapy are associated with higher 6-month mortality, but this relationship may be even more critical in patients receiving fibrinolytic therapy.

PMID:
17591643
PMCID:
PMC2095752
DOI:
10.1136/hrt.2006.112847
[Indexed for MEDLINE]
Free PMC Article

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