Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events
Center for Outcomes Research; Department of Medicine, Division of Cardiovascular Medicine
Medical Subject Headings
Angioplasty, Balloon, Coronary; Cohort Studies; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Myocardial Infarction; Prospective Studies; Regression Analysis; Thrombolytic Therapy; Time Factors; Treatment Outcome
Health Services Research
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.
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Citation: Heart. 2007 Dec;93(12):1552-5. Epub 2007 Jun 25. Link to article on publisher's site
Nallamothu, Brahmajee K.; Fox, Keith A. A.; Kennelly, Brian M.; Van de Werf, Frans; Gore, Joel M.; Steg, Phillippe Gabriel; Granger, Christopher B.; Dabbous, Omar H.; Kline-Rogers, Eva M.; and Eagle, Kim A., "Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events" (2007). GRACE Publications. Paper 47.