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(Circulation. 2004;109:1806-1808.)
© 2004 American Heart Association, Inc.

Focused Perspective

Treatment Delayed Is Treatment Denied

David O. Williams, MD

From the Division of Cardiology, Department of Medicine, Brown Medical School, Providence, RI.

Correspondence to David O. Williams, MD, APC 814, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903. E-mail dowilliams@lifespan.org

Key Words: Focused Perspectives • myocardial infarction • reperfusion • angioplasty • revascularization

An extract of the first 250 words of the full text is provided, because this article has no abstract.

You may delay, but time will not.

— —Benjamin Franklin

In 1977, Reimer and coworkers published in this journal the results of an experiment that established the basis of reperfusion therapy for patients with ST-elevation myocardial infarction (STEMI).¹ These investigators identified a relationship between the duration of acute coronary occlusion and the magnitude of subsequent myocardial necrosis. In other words, the extent of infarct size that resulted from sustained occlusion could be reduced if the occlusion were interrupted and flow restored. Furthermore, reductions in the duration of occlusion were associated with incremental decreases in infarct size.

See Circulation. 2004;109:1223–1225

Such relationships were confirmed in early investigations of thrombolytic therapy for STEMI.^2,3 Consequences of earlier treatment were improvements in indices of left ventricular systolic function and reductions in mortality rate. Although there was, in general, a linear relationship between time to treatment and outcome, the very best results were obtained when thrombolysis was initiated within the first hour.^4,5

To this point, such a tight relationship between time to treatment and outcome has been less apparent when primary angioplasty is selected as the method for achieving reperfusion. Reports on this subject describe conflicting findings. With these considerations in mind, De Luca and colleagues performed a single-center database analysis and reported their results in the March 16, 2004, issue of Circulation.⁶ They reviewed the baseline and angiographic characteristics and clinical outcomes of 1791 patients with STEMI who were treated by primary angioplasty. Time to treatment was defined as the elapsed time . . . [Full Text of this Article]

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