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(Circulation. 2005;111:718-720.)
© 2005 American Heart Association, Inc.

Editorial

Transfer for Primary Angioplasty

The Importance of Time

Howard C. Herrmann, MD

From the Cardiovascular Division, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia.

Correspondence to Howard C. Herrmann, MD, Professor of Medicine and Director, Interventional Cardiology and Cardiac Catheterization Laboratories, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce St, Philadelphia 19104. E-mail Howard.herrmann@uphs.upenn.edu

Key Words: Editorials • angioplasty • fibrinolysis • myocardial infarction • catheterization

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

	Introduction

 
Primary angioplasty offers benefits as compared with fibrinolysis for many patients with acute ST-elevation myocardial infarction (STEMI).¹ This superiority of percutaneous coronary intervention (PCI) in trials has led to the investigation of transfer strategies that would make PCI more widely available. Such a strategy would regionalize care and divert patients with STEMI to centers with PCI capability. The clinical cost of such a strategy in terms of time requires investigation.

See p 761

Time to reperfusion after fibrinolysis is a critical determinant of outcome.^2–4 In some reports of primary angioplasty, the time to reperfusion has had little effect on mortality.⁵ In most other studies, however, a longer door-to-balloon time worsened outcome as assessed by myocardial infarct size as well as mortality.^6–9 In one recent analysis of 1791 patients with STEMI treated by primary angioplasty, each 30-minute delay in reperfusion was associated with a relative risk for 1-year mortality of 1.075.¹⁰ In a retrospective analysis of randomized trials that compared fibrinolysis to primary angioplasty, the mortality benefit associated with PCI was lost when the door-to-balloon time was delayed by >1 hour as compared with the door-to-needle time.¹¹ Some of the difference in the comparison of fibrinolysis and primary angioplasty may reflect a relative decrease in the efficacy of fibrinolysis with time after symptom onset^12,13 or the relatively good outcome that occurs in the lowest-risk STEMI patients.¹⁴ On the basis of the benefit associated with primary angioplasty over fibrinolysis in randomized trials, new trials were designed and carried out that involved transferring . . . [Full Text of this Article]

Related Article:

Times to Treatment in Transfer Patients Undergoing Primary Percutaneous Coronary Intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 Analysis

Brahmajee K. Nallamothu, Eric R. Bates, Jeph Herrin, Yongfei Wang, Elizabeth H. Bradley, Harlan M. Krumholz for the NRMI Investigators
Circulation 2005 111: 761-767. [Abstract] [Full Text]

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