Circulation. 2003;108:2851-2856
Published online before print November 17, 2003, doi: 10.1161/01.CIR.0000103122.10021.F2
Published online before print November 17, 2003, doi: 10.1161/01.CIR.0000103122.10021.F2
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2003;108:2851.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Impact of Time to Treatment on Mortality After Prehospital Fibrinolysis or Primary Angioplasty
Data From the CAPTIM Randomized Clinical Trial
From the Service de Cardiologie (P.G.S.), Hôpital Bichat, Paris, and Service de Cardiologie (E.B., P.T.), Hôpital Cardio-Vasculaire et Pneumologique Louis Pradel, Lyon; Service de Pharmacologie Clinique (S.C., A.L.), Faculte RTH Laennec, Lyon; SAMU 93 (F.L.), Bobigny; SAMU 69 (P.-Y.D.), Lyon; and SAMU 75 (P.C.), Paris, France.
Reprint requests to Philippe Gabriel Steg, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. E-mail gabriel.steg{at}bch.ap-hop-paris.fr
Received August 1, 2003; revision received September 16, 2003; accepted September 22, 2003.
Background— CAPTIM was a randomized trial comparing prehospital thrombolysis with transfer to an interventional facility (and, if needed, percutaneous intervention) with primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI). Because the benefit of thrombolysis is maximal during the first 2 hours after symptom onset, and because prehospital thrombolysis can be implemented earlier than PCI, this analysis studied the relationship between the effect of assigned treatment and the time elapsed from symptom onset.
Methods and Results— Randomization within 2 hours (n=460) or 
2 hours (n=374) after symptom onset had no impact on the effect of treatment on the 30-day combined primary end point of death, nonfatal reinfarction, and disabling stroke. However, patients randomized <2 hours after symptom onset had a strong trend toward lower 30-day mortality with prehospital thrombolysis compared with those randomized to primary PCI (2.2% versus 5.7%, P=0.058), whereas mortality was similar in patients randomized 2 hours (5.9% versus 3.7%, P=0.47). There was a significant interaction between treatment effect and delay with respect to 30-day mortality (hazard ratio 4.19, 95% CI 1.033 to 17.004, P=0.045). Among patients randomized in the first 2 hours, cardiogenic shock was less frequent with lytic therapy than with primary PCI (1.3% versus 5.3%, P=0.032), whereas rates were similar in patients randomized later.
Conclusions— Time from symptom onset should be considered when one selects reperfusion therapy in STEMI. Prehospital thrombolysis may be preferable to primary PCI for patients treated within the first 2 hours after symptom onset.
Key Words: angioplasty • myocardial infarction • reperfusion • thrombolysis
Related Article:
Circulation 2003 108: 2828-2830.
This article has been cited by other articles:
 |
|
 |
|
  S. G. Goodman, V. Menon, C. P. Cannon, G. Steg, E. M. Ohman, and R. A. Harrington Acute ST-Segment Elevation Myocardial Infarction: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 708S - 775S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. R. Reynolds and J. S. Hochman Cardiogenic Shock: Current Concepts and Improving Outcomes Circulation, February 5, 2008; 117(5): 686 - 697. [Full Text] [PDF]
|
|
|
|
 |
|
 D. R. Holmes Jr, M. R. Bell, B. J. Gersh, C. S. Rihal, L. H. Haro, C. M. Bjerke, R. J. Lennon, C.-C. Lim, and H. H. Ting Systems of Care to Improve Timeliness of Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction During Off Hours: The Mayo Clinic STEMI Protocol J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 88 - 96. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A T Ratcliffe and C Pepper Thrombolysis or primary angioplasty? Reperfusion therapy for myocardial infarction in the UK Postgrad. Med. J., February 1, 2008; 84(988): 73 - 77. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Kapoor, J. R. Kapoor, V. Gurewich, S. Szabo, T. Oikonomopoulos, H. M. Hoffmeister, B. K. Nallamothu, E. H. Bradley, and H. M. Krumholz Primary Percutaneous Coronary Intervention N. Engl. J. Med., January 24, 2008; 358(4): 431 - 433. [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Eskola, L. Holmvang, K. C. Nikus, S. Sclarovsky, H.-H. Tilsted, H. Huhtala, K. O. Niemela, and P. Clemmensen The electrocardiographic window of opportunity to treat vs. the different evolving stages of ST-elevation myocardial infarction: correlation with therapeutic approach, coronary anatomy, and outcome in the DANAMI-2 trial Eur. Heart J., December 2, 2007; 28(24): 2985 - 2991. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kasapis and B. K. Nallamothu Use of the electrocardiogram in optimizing reperfusion for ST-elevation myocardial infarction: a new role for an old tool? Eur. Heart J., December 2, 2007; 28(24): 2957 - 2959. [Full Text] [PDF]
|
|
|
|
 |
|
 N R Castle, R C Owen, and M Hann Is there still a place for emergency department thrombolysis following the introduction of the amended Joint Royal Colleges Ambulance Liaison Committee criteria for thrombolysis? Emerg. Med. J., December 1, 2007; 24(12): 843 - 845. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Carstensen, G. C.I. Nelson, P. S. Hansen, L. Macken, S. Irons, M. Flynn, P. Kovoor, S. Y. Soo Hoo, M. R. Ward, and H. H. Rasmussen Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome Eur. Heart J., October 1, 2007; 28(19): 2313 - 2319. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. E. Boden, K. Eagle, and C. B. Granger Reperfusion Strategies in Acute ST-Segment Elevation Myocardial Infarction: A Comprehensive Review of Contemporary Management Options J. Am. Coll. Cardiol., September 4, 2007; 50(10): 917 - 929. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. H. Ting, C. S. Rihal, B. J. Gersh, L. H. Haro, C. M. Bjerke, R. J. Lennon, C.-C. Lim, J. F. Bresnahan, A. S. Jaffe, D. R. Holmes, et al. Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for ST-Elevation Myocardial Infarction: The Mayo Clinic STEMI Protocol Circulation, August 14, 2007; 116(7): 729 - 736. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Moyer, J. P. Ornato, W. J. Brady Jr, L. L. Davis, C. A. Ghaemmaghami, W. B. Gibler, G. Mears, V. N. Mosesso Jr, and R. D. Zane Development of Systems of Care for ST-Elevation Myocardial Infarction Patients: The Emergency Medical Services and Emergency Department Perspective Circulation, July 10, 2007; 116(2): e43 - e48. [Full Text] [PDF]
|
|
|
|
|
|
T. J. Kiernan, H. H. Ting, and B. J. Gersh Facilitated percutaneous coronary intervention: current concepts, promises, and pitfalls Eur. Heart J., July 1, 2007; 28(13): 1545 - 1553. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Travers Achieving optimal care for ST-segment elevation myocardial infarction in Canada Can. Med. Assoc. J., June 19, 2007; 176(13): 1843 - 1844. [Full Text] [PDF]
|
|
|
|
|
|
K. P. Alexander, L. K. Newby, P. W. Armstrong, C. P. Cannon, W. B. Gibler, M. W. Rich, F. Van de Werf, H. D. White, W. D. Weaver, M. D. Naylor, et al. Acute Coronary Care in the Elderly, Part II: ST-Segment-Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology Circulation, May 15, 2007; 115(19): 2570 - 2589. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Fernandez-Aviles, J. J. Alonso, G. Pena, J. Blanco, J. Alonso-Briales, J. Lopez-Mesa, F. Fernandez-Vazquez, J. Moreu, R. A. Hernandez, A. Castro-Beiras, et al. Primary angioplasty vs. early routine post-fibrinolysis angioplasty for acute myocardial infarction with ST-segment elevation: the GRACIA-2 non-inferiority, randomized, controlled trial Eur. Heart J., April 2, 2007; 28(8): 949 - 960. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Pinto, A. J. Kirtane, B. K. Nallamothu, S. A. Murphy, D. J. Cohen, R. J. Laham, D. E. Cutlip, E. R. Bates, P. D. Frederick, D. P. Miller, et al. Hospital Delays in Reperfusion for ST-Elevation Myocardial Infarction: Implications When Selecting a Reperfusion Strategy Circulation, November 7, 2006; 114(19): 2019 - 2025. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Sejersten, Y Birnbaum, R S Ripa, C Maynard, G S Wagner, P Clemmensen, and for the DANAMI-2 Investigators Influences of electrocardiographic ischaemia grades and symptom duration on outcomes in patients with acute myocardial infarction treated with thrombolysis versus primary percutaneous coronary intervention: results from the DANAMI-2 trial Heart, November 1, 2006; 92(11): 1577 - 1582. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. H. Ting, E. H. Yang, and C. S. Rihal Narrative review: reperfusion strategies for ST-segment elevation myocardial infarction. Ann Intern Med, October 17, 2006; 145(8): 610 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Stenestrand, J. Lindback, L. Wallentin, and for the RIKS-HIA Registry Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA, October 11, 2006; 296(14): 1749 - 1756. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-P. Collet, G. Montalescot, M. Le May, M. Borentain, and A. Gershlick Percutaneous Coronary Intervention After Fibrinolysis: A Multiple Meta-Analyses Approach According to the Type of Strategy J. Am. Coll. Cardiol., October 3, 2006; 48(7): 1326 - 1335. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P G Steg, J-P Cambou, P Goldstein, E Durand, P Sauval, Z Kadri, D Blanchard, J-M Lablanche, P Gueret, Y Cottin, et al. Bypassing the emergency room reduces delays and mortality in ST elevation myocardial infarction: the USIC 2000 registry Heart, October 1, 2006; 92(10): 1378 - 1383. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. H RAINER and N. Y.L LAM Circulating Nucleic Acids and Critical Illness. Ann. N.Y. Acad. Sci., September 1, 2006; 1075: 271 - 277. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Ortolani, A. Marzocchi, C. Marrozzini, T. Palmerini, F. Saia, C. Serantoni, M. Aquilina, S. Silenzi, F. Baldazzi, D. Grosseto, et al. Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction Eur. Heart J., July 1, 2006; 27(13): 1550 - 1557. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Armstrong and WEST Steering Committee A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST (Which Early ST-elevation myocardial infarction Therapy) study Eur. Heart J., July 1, 2006; 27(13): 1530 - 1538. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. G. Steg and N. Danchin WEST: new data on the integration of early thrombolysis and mechanical intervention in the early management of STEMI Eur. Heart J., July 1, 2006; 27(13): 1511 - 1512. [Full Text] [PDF]
|
|
|
|
|
|
D Gray Thrombolysis: past, present, and future. Postgrad. Med. J., June 1, 2006; 82(968): 372 - 375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Danchin Should intravenous thrombolysis keep a place in the treatment of acute ST-elevation myocardial infarction? Eur. Heart J., May 2, 2006; 27(10): 1131 - 1133. [Full Text] [PDF]
|
|
|
|
|
|
E. Bjorklund, U. Stenestrand, J. Lindback, L. Svensson, L. Wallentin, B. Lindahl, and on behalf of the RIKS-HIA Investigators Pre-hospital thrombolysis delivered by paramedics is associated with reduced time delay and mortality in ambulance-transported real-life patients with ST-elevation myocardial infarction Eur. Heart J., May 2, 2006; 27(10): 1146 - 1152. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Rathore, A. J. Epstein, B. K. Nallamothu, and H. M. Krumholz Regionalization of ST-Segment Elevation Acute Coronary Syndromes Care: Putting a National Policy in Proper Perspective J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1346 - 1349. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Gersh and E. M. Antman Selection of the optimal reperfusion strategy for STEMI: does time matter? Eur. Heart J., April 1, 2006; 27(7): 761 - 763. [Full Text] [PDF]
|
|
|
|
|
|
E. Boersma and The Primary Coronary Angioplasty vs. Thrombolysis Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients Eur. Heart J., April 1, 2006; 27(7): 779 - 788. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Part 8: Stabilization of the Patient With Acute Coronary Syndromes Circulation, December 13, 2005; 112(24_suppl): IV-89 - IV-110. [Full Text] [PDF]
|
|
|
|
|
|
B. J. Witt, R. D. Brown Jr., S. J. Jacobsen, S. A. Weston, B. P. Yawn, and V. L. Roger A Community-Based Study of Stroke Incidence after Myocardial Infarction Ann Intern Med, December 6, 2005; 143(11): 785 - 792. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-P. Bassand, N. Danchin, G. Filippatos, A. Gitt, C. Hamm, S. Silber, M. Tubaro, and F. Weidinger Implementation of reperfusion therapy in acute myocardial infarction. A policy statement from the European Society of Cardiology Eur. Heart J., December 2, 2005; 26(24): 2733 - 2741. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R C Welsh and P W Armstrong It's a matter of time: contemporary pre-hospital management of acute ST elevation myocardial infarction Heart, December 1, 2005; 91(12): 1524 - 1526. [Full Text] [PDF]
|
|
|
|
|
|
B R Brodie Facilitated percutaneous coronary intervention Heart, December 1, 2005; 91(12): 1527 - 1529. [Full Text] [PDF]
|
|
|
|
|
|
A de Belder Should primary angioplasty be available for all patients with an ST elevation myocardial infarction? Heart, December 1, 2005; 91(12): 1509 - 1511. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Part 5: Acute Coronary Syndromes Circulation, November 29, 2005; 112(22_suppl): III-55 - III-72. [Full Text] [PDF]
|
|
|
|
|
|
R C Welsh, W Chang, P Goldstein, J Adgey, C B Granger, F W A Verheugt, L Wallentin, F Van de Werf, P W Armstrong, and on behalf of the ASSENT-3 PLUS Investigators Time to treatment and the impact of a physician on prehospital management of acute ST elevation myocardial infarction: insights from the ASSENT-3 PLUS trial Heart, November 1, 2005; 91(11): 1400 - 1406. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Tarantini, L. Cacciavillani, F. Corbetti, A. Ramondo, M. P. Marra, E. Bacchiega, M. Napodano, C. Bilato, R. Razzolini, and S. Iliceto Duration of Ischemia Is a Major Determinant of Transmurality and Severe Microvascular Obstruction After Primary Angioplasty: A Study Performed With Contrast-Enhanced Magnetic Resonance J. Am. Coll. Cardiol., October 4, 2005; 46(7): 1229 - 1235. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Thiele, L. Engelmann, K. Elsner, M. J. Kappl, W.-H. Storch, K. Rahimi, A. Hartmann, D. Pfeiffer, G. D. Kneissl, D. Schneider, et al. Comparison of pre-hospital combination-fibrinolysis plus conventional care with pre-hospital combination-fibrinolysis plus facilitated percutaneous coronary intervention in acute myocardial infarction Eur. Heart J., October 1, 2005; 26(19): 1956 - 1963. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Beygui and G. Montalescot The use of GP IIb/IIIa inhibitors into new perspectives: pre-catheterization laboratory administration Eur. Heart J. Suppl., October 1, 2005; 7(suppl_I): I10 - I14. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Bonnefoy, P. G. Steg, S. Chabaud, P.-Y. Dubien, F. Lapostolle, F. Boudet, J.-M. Lacroute, F. Dissait, G. Vanzetto, A. Leizorowicz, et al. Is primary angioplasty more effective than prehospital fibrinolysis in diabetics with acute myocardial infarction? Data from the CAPTIM randomized clinical trial Eur. Heart J., September 1, 2005; 26(17): 1712 - 1718. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P G Steg and J-M Juliard Primary percutaneous coronary intervention in acute myocardial infarction: time, time, and time! Heart, August 1, 2005; 91(8): 993 - 994. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. G. Rosenfeld, A. Lindauer, and B. G. Darney Understanding Treatment-Seeking Delay in Women with Acute Myocardial Infarction: Descriptions of Decision-Making Patterns Am. J. Crit. Care., July 1, 2005; 14(4): 285 - 293. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-P. Bassand, S. Priori, and M. Tendera Evidence-based vs. 'impressionist' medicine: how best to implement guidelines Eur. Heart J., June 2, 2005; 26(12): 1155 - 1158. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H R Andersen, C J Terkelsen, L Thuesen, L R Krusell, S D Kristensen, H E Botker, J F Lassen, and T T Nielsen Myocardial infarction centres: the way forward Heart, June 1, 2005; 91(suppl_3): iii12 - iii15. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Armstrong, P. Bogaty, C. E. Buller, and B. J. O'Neill Guidelines for STEMI Can. Med. Assoc. J., May 24, 2005; 172(11): 1426 - 1426. [Full Text] [PDF]
|
|
|
|
 |
|
 J. N Townend and S. N Doshi Reducing mortality in myocardial infarction BMJ, April 16, 2005; 330(7496): 856 - 857. [Full Text] [PDF]
|
|
|
|
|
|
S. S. Rathore, A. J. Epstein, K. G. M. Volpp, and H. M. Krumholz Regionalization of Care for Acute Coronary Syndromes: More Evidence Is Needed JAMA, March 16, 2005; 293(11): 1383 - 1387. [Full Text] [PDF]
|
|
|
|
|
|
A. J.J. McClelland, C. G. Owens, S. J. Walsh, D. McCarty, T. Mathew, M. Stevenson, H. Gracey, M. M. Khan, and A.A. J. Adgey Percutaneous coronary intervention and 1 year survival in patients treated with fibrinolytic therapy for acute ST-elevation myocardial infarction Eur. Heart J., March 2, 2005; 26(6): 544 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Gersh, G. W. Stone, H. D. White, and D. R. Holmes Jr Pharmacological Facilitation of Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: Is the Slope of the Curve the Shape of the Future? JAMA, February 23, 2005; 293(8): 979 - 986. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Machecourt, E. Bonnefoy, G. Vanzetto, P. Motreff, S. Marliere, A. Leizorovicz, B. Allenet, J. M. Lacroute, J. Cassagnes, and P. Touboul Primary angioplasty is cost-minimizing compared with pre-hospital thrombolysis for patients within 60 min of a percutaneous coronary intervention center: The Comparison of Angioplasty and Pre-hospital Thrombolysis in Acute Myocardial Infarction (CAPTIM) cost-efficacy sub-study J. Am. Coll. Cardiol., February 15, 2005; 45(4): 515 - 524. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. C. Herrmann Transfer for Primary Angioplasty: The Importance of Time Circulation, February 15, 2005; 111(6): 718 - 720. [Full Text] [PDF]
|
|