(Circulation. 1999;100:14-20.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Relationship Between Delay in Performing Direct Coronary Angioplasty and Early Clinical Outcome in Patients With Acute Myocardial Infarction
Results From the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IIb) Trial
From the Division of Cardiovascular Diseases, Mayo Clinic (P.B.B., D.R.H.), Rochester, Minn; the Department of Cardiology, Cleveland Clinic (S.G.E., E.J.T.), Cleveland, Ohio; the Division of Cardiology, Duke University (C.B.G., D.A.C., R.M.C.), Durham, NC; and Hospital Clinic 1, Provincial de Barcelona (A.B.), Barcelona, Spain.
Correspondence to Peter B. Berger, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail berger.peter{at}mayo.edu
Background—Time to treatment with thrombolytic therapy is a critical determinant of mortality in acute myocardial infarction. Little is known about the relationship between the time to treatment with direct coronary angioplasty and clinical outcome. The objectives of this study were to determine both the time required to perform direct coronary angioplasty in the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IIb) trial and its relationship to clinical outcome.
Methods and Results—Patients randomized to direct
coronary angioplasty (n=565) were divided into groups based on
the time between study enrollment and first balloon inflation. Patients
randomized to angioplasty who did not undergo the procedure were also
analyzed. The median time from study enrollment to first
balloon inflation was 76 minutes; 19% of patients assigned to
angioplasty did not undergo an angioplasty procedure. The 30-day
mortality rate of patients who underwent balloon inflation 
60 minutes
after study enrollment was 1.0%; 61 to 75 minutes after enrollment,
3.7%; 76 to 90 minutes after enrollment, 4.0%; and 
91 minutes after
enrollment, 6.4%. The mortality rate of patients assigned to
angioplasty who never underwent the procedure was 14.1%
(P=0.001). Logistic regression analysis revealed
that the time from enrollment to first balloon inflation was a
significant predictor of mortality within 30 days; after adjustment for
differences in baseline characteristics, the odds of death increased
1.6 times (P=0.008) for a movement from each time
interval to the next.
Conclusions—The time to treatment with direct PTCA, as with thrombolytic therapy, is a critical determinant of mortality.
Key Words: reperfusion • myocardial infarction • angioplasty • mortality • survival
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M. Singh, H. H. Ting, P. B. Berger, K. N. Garratt, D. R. Holmes Jr, and B. J. Gersh Rationale for on-site cardiac surgery for primary angioplasty: a time for reappraisal J. Am. Coll. Cardiol., June 19, 2002; 39(12): 1881 - 1889. [Abstract] [Full Text] [PDF]
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D. R. Thiemann Primary angioplasty for elderly patients with myocardial infarction: Theory, practice and possibilities J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1729 - 1732. [Full Text] [PDF]
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F Zijlstra, A Patel, M Jones, C.L Grines, S Ellis, E Garcia, L Grinfeld, R.J Gibbons, E.E Ribeiro, F Ribichini, et al. Clinical characteristics and outcome of patients with early (<2h), intermediate (2-4h) and late (>4h) presentation treated by primary coronary angioplasty or thrombolytic therapy for acute myocardial infarction Eur. Heart J., April 1, 2002; 23(7): 550 - 557. [Abstract] [Full Text] [PDF]
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D. Faxon and C. Lenfant Timing Is Everything: Motivating Patients to Call 9-1-1 at Onset of Acute Myocardial Infarction Circulation, September 11, 2001; 104(11): 1210 - 1211. [Full Text] [PDF]
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G. W. Stone, D. Cox, E. Garcia, B. R. Brodie, M.-C. Morice, J. Griffin, L. Mattos, A. J. Lansky, W. W. O'Neill, and C. L. Grines Normal Flow (TIMI-3) Before Mechanical Reperfusion Therapy Is an Independent Determinant of Survival in Acute Myocardial Infarction: Analysis From the Primary Angioplasty in Myocardial Infarction Trials Circulation, August 7, 2001; 104(6): 636 - 641. [Abstract] [Full Text] [PDF]
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H. Hashimoto, K. Kitagawa, H. Hougaku, Y. Shimizu, M. Sakaguchi, Y. Nagai, S. Iyama, H. Yamanishi, M. Matsumoto, and M. Hori C-Reactive Protein Is an Independent Predictor of the Rate of Increase in Early Carotid Atherosclerosis Circulation, July 3, 2001; 104(1): 63 - 67. [Abstract] [Full Text] [PDF]
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C Loubeyre, T Lefevre, Y Louvard, P Dumas, J.-F Piechaud, J.-J Lanore, J.-F Angellier, J.-Y Le Tarnec, G Karrillon, A Margenet, et al. Outcome after combined reperfusion therapy for acute myocardial infarction, combining pre-hospital thrombolysis with immediate percutaneous coronary intervention and stent Eur. Heart J., July 1, 2001; 22(13): 1128 - 1135. [Abstract] [PDF]
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G. Montalescot, P. Barragan, O. Wittenberg, P. Ecollan, S. Elhadad, P. Villain, J.-M. Boulenc, M.-C. Morice, L. Maillard, M. Pansieri, et al. Platelet Glycoprotein IIb/IIIa Inhibition with Coronary Stenting for Acute Myocardial Infarction N. Engl. J. Med., June 21, 2001; 344(25): 1895 - 1903. [Abstract] [Full Text] [PDF]
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P. W. Armstrong and D. Collen Fibrinolysis for Acute Myocardial Infarction : Current Status and New Horizons for Pharmacological Reperfusion, Part 2 Circulation, June 19, 2001; 103(24): 2987 - 2992. [Full Text] [PDF]
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B. M. R. Spiegel, N. B. Vakil, and J. J. Ofman Endoscopy for Acute Nonvariceal Upper Gastrointestinal Tract Hemorrhage: Is Sooner Better?: A Systematic Review Arch Intern Med, June 11, 2001; 161(11): 1393 - 1404. [Abstract] [Full Text] [PDF]
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R. Zahn, R. Schiele, S. Schneider, A. K. Gitt, H. Wienbergen, K. Seidl, T. Voigtlander, M. Gottwik, G. Berg, E. Altmann, et al. Primary angioplasty versus intravenous thrombolysis in acute myocardial infarction: can we define subgroups of patients benefiting most from primary angioplasty?: Results from the pooled data of the maximal individual therapy in acute myocardial infarction registry and the myocardial infarction registry J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1827 - 1835. [Abstract] [Full Text] [PDF]
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P. Widimsky Pharmacological versus catheter-based reperfusion: What is present state of the art? Eur. Heart J. Suppl., June 1, 2001; 3(suppl_C): C47 - C54. [Abstract] [PDF]
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P.B. Berger and B.J. Gersh Ventricular function after primary angioplasty for acute myocardial infarction: correlates and caveats Eur. Heart J., May 1, 2001; 22(9): 726 - 728. [PDF]
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R. Zahn, R. Schiele, S. Schneider, A. K. Gitt, H. Wienbergen, K. Seidl, C. Bossaller, H. J. Buttner, M. Gottwik, E. Altmann, et al. Decreasing hospital mortality between 1994 and 1998 in patients with acute myocardial infarction treated with primary angioplasty but not in patients treated with intravenous thrombolysis: Results from the pooled data of the maximal individual therapy in acute myocardial infarction (MITRA) registry and the myocardial infarction registry (MIR) J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2064 - 2071. [Abstract] [Full Text] [PDF]
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S. Ojio, H. Takatsu, T. Tanaka, K. Ueno, K. Yokoya, T. Matsubara, T. Suzuki, S. Watanabe, N. Morita, M. Kawasaki, et al. Considerable Time From the Onset of Plaque Rupture and/or Thrombi Until the Onset of Acute Myocardial Infarction in Humans : Coronary Angiographic Findings Within 1 Week Before the Onset of Infarction Circulation, October 24, 2000; 102(17): 2063 - 2069. [Abstract] [Full Text] [PDF]
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B. R. Brodie, G. Kissling, P. B. Berger, D. A. Criger, D. R. Holmes Jr, S. G. Ellis, C. B. Granger, A. Betriu, E. J. Topol, and R. M. Califf Relationship Between Delay in Performing Direct Coronary Angioplasty and Early Clinical Outcome in Patients With Acute Myocardial Infarction Response Circulation, July 25, 2000; 102 (4): e29 - e30. [Full Text] [PDF]
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C. P. Cannon, C. M. Gibson, C. T. Lambrew, D. A. Shoultz, D. Levy, W. J. French, J. M. Gore, W. D. Weaver, W. J. Rogers, and A. J. Tiefenbrunn Relationship of Symptom-Onset-to-Balloon Time and Door-to-Balloon Time With Mortality in Patients Undergoing Angioplasty for Acute Myocardial Infarction JAMA, June 14, 2000; 283(22): 2941 - 2947. [Abstract] [Full Text] [PDF]
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P. B. Berger, N. Danchin, L. Vaur, N. Genes, S. Etienne, M. Angioi, J. Ferrieres, and J.-P. Cambou Treatment of Acute Myocardial Infarction by Primary Coronary Angioplasty or Intravenous Thrombolysis Response Circulation, May 30, 2000; 101 (21): e211 - e212. [Full Text] [PDF]
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D. Thiemann, A. K. Berger, K. A. Schulman, B. J. Gersh, and N. R. Every Primary Angioplasty vs Thrombolysis in Elderly Patients JAMA, February 2, 2000; 283(5): 601 - 602. [Full Text] [PDF]
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K. Sheikh, D. R. Thiemann, J. Coresh, N. R. Powe, and E. L. Hannan The Relation between Volume and Outcome in Health Care N. Engl. J. Med., September 30, 1999; 341(14): 1085 - 1086. [Full Text]
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