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. 47.