Circulation. 2004;109:1223-1225
Published online before print March 8, 2004, doi: 10.1161/01.CIR.0000121424.76486.20
Published online before print March 8, 2004, doi: 10.1161/01.CIR.0000121424.76486.20
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(Circulation. 2004;109:1223-1225.)
© 2004 American Heart Association, Inc.
Brief Rapid Communications |
Time Delay to Treatment and Mortality in Primary Angioplasty for Acute Myocardial Infarction
Every Minute of Delay Counts
From the Department of Cardiology (G.D.L., H.S., J.P.O.), ISALA Klinieken, Zwolle, The Netherlands, and Cardiovascular Division (E.M.A.), Brigham and Women’s Hospital, Boston, Mass.
Correspondence to Harry Suryapranata, MD, PhD, Department of Cardiology, ISALA Klinieken, Hospital De Weezenlanden, Groot Wezeland 20, 8011 JW Zwolle, The Netherlands. E-mail h.suryapranata{at}diagram-zwolle.nl
Received November 6, 2003; revision received January 23, 2004; accepted January 27, 2004.
Background— Although the relationship between mortality and time delay to treatment has been demonstrated in patients with acute ST-segment elevation myocardial infarction (STEMI) treated by thrombolysis, the impact of time delay on prognosis in patients undergoing primary angioplasty has yet to be clarified. The aim of this report was to address the relationship between time to treatment and mortality as a continuous function and to estimate the risk of mortality for each 30-minute delay.
Methods and Results— The study population consisted of 1791 patients with STEMI treated by primary angioplasty. The relationship between ischemic time and 1-year mortality was assessed as a continuous function and plotted with a quadratic regression model. The Cox proportional hazards regression model was used to calculate relative risks (for each 30 minutes of delay), adjusted for baseline characteristics related to ischemic time. Variables related to time to treatment were age >70 years (P<0.0001), female gender (P=0.004), presence of diabetes mellitus (P=0.002), and previous revascularization (P=0.035). Patients with successful reperfusion had a significantly shorter ischemic time (P=0.006). A total of 103 patients (5.8%) had died at 1-year follow-up. After adjustment for age, gender, diabetes, and previous revascularization, each 30 minutes of delay was associated with a relative risk for 1-year mortality of 1.075 (95% CI 1.008 to 1.15; P=0.041).
Conclusions— These results suggest that every minute of delay in primary angioplasty for STEMI affects 1-year mortality, even after adjustment for baseline characteristics. Therefore, all efforts should be made to shorten the total ischemic time, not only for thrombolytic therapy but also for primary angioplasty.
Key Words: myocardial infarction • prognosis • mortality • angioplasty
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J. S. Hochman, L. A. Sleeper, J. G. Webb, V. Dzavik, C. E. Buller, P. Aylward, J. Col, H. D. White, and for the SHOCK Investigators Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA, June 7, 2006; 295(21): 2511 - 2515. [Abstract] [Full Text] [PDF]
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K. Kalla, G. Christ, R. Karnik, R. Malzer, G. Norman, H. Prachar, W. Schreiber, G. Unger, H. D. Glogar, A. Kaff, et al. Implementation of Guidelines Improves the Standard of Care: The Viennese Registry on Reperfusion Strategies in ST-Elevation Myocardial Infarction (Vienna STEMI Registry) Circulation, May 23, 2006; 113(20): 2398 - 2405. [Abstract] [Full Text] [PDF]
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The American Heart Association's Acute Myocardial, A. K. Jacobs, E. M. Antman, G. Ellrodt, D. P. Faxon, T. Gregory, G. A. Mensah, P. Moyer, J. Ornato, E. D. Peterson, et al. Recommendation to Develop Strategies to Increase the Number of ST-Segment-Elevation Myocardial Infarction Patients With Timely Access to Primary Percutaneous Coronary Intervention Circulation, May 2, 2006; 113(17): 2152 - 2163. [Abstract] [Full Text] [PDF]
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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]
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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]
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B. K. Nallamothu, E. R. Bates, Y. Wang, E. H. Bradley, and H. M. Krumholz Driving Times and Distances to Hospitals With Percutaneous Coronary Intervention in the United States: Implications for Prehospital Triage of Patients With ST-Elevation Myocardial Infarction Circulation, March 7, 2006; 113(9): 1189 - 1195. [Abstract] [Full Text] [PDF]
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A. D. Banks and K. Dracup Factors Associated With Prolonged Prehospital Delay of African Americans With Acute Myocardial Infarction Am. J. Crit. Care., March 1, 2006; 15(2): 149 - 157. [Abstract] [Full Text] [PDF]
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G. De Luca, H. Suryapranata, G. W. Stone, D. Antoniucci, J. E. Tcheng, F.-J. Neumann, E. Bonizzoni, E. J. Topol, and M. Chiariello Relationship Between Patient's Risk Profile and Benefits in Mortality From Adjunctive Abciximab to Mechanical Revascularization for ST-Segment Elevation Myocardial Infarction: A Meta-Regression Analysis of Randomized Trials J. Am. Coll. Cardiol., February 7, 2006; 47(3): 685 - 686. [Full Text] [PDF]
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J. L. Garvey, B. A. MacLeod, G. Sopko, M. M. Hand, and on behalf of the National Heart Attack Alert Progr Pre-Hospital 12-Lead Electrocardiography Programs: A Call for Implementation by Emergency Medical Services Systems Providing Advanced Life Support--National Heart Attack Alert Program (NHAAP) Coordinating Committee; National Heart, Lung, and Blood Institute (NHLBI); National Institutes of Health J. Am. Coll. Cardiol., February 7, 2006; 47(3): 485 - 491. [Abstract] [Full Text] [PDF]
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R. L. McNamara, J. Herrin, E. H. Bradley, E. L. Portnay, J. P. Curtis, Y. Wang, D. J. Magid, M. Blaney, H. M. Krumholz, and for the NRMI Investigators Hospital Improvement in Time to Reperfusion in Patients With Acute Myocardial Infarction, 1999 to 2002 J. Am. Coll. Cardiol., January 3, 2006; 47(1): 45 - 51. [Abstract] [Full Text] [PDF]
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S. C. Smith Jr, T. E. Feldman, J. W. Hirshfeld Jr, A. K. Jacobs, M. J. Kern, S. B. King III, D. A. Morrison, W. W. O'Neill, H. V. Schaff, P. L. Whitlow, et al. ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention) J. Am. Coll. Cardiol., January 3, 2006; 47(1): 216 - 235. [Full Text] [PDF]
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S. C. Smith Jr, T. E. Feldman, J. W. Hirshfeld Jr, A. K. Jacobs, M. J. Kern, S. B. King III, D. A. Morrison, W. W. O'Neill, H. V. Schaff, P. L. Whitlow, et al. ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention) Circulation, January 3, 2006; 113(1): 156 - 175. [Full Text] [PDF]
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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]
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T. P. Wharton Jr, E. C. Keeley, C. L. Grines, T. P. Wharton Jr, E. C. Keeley, and C. L. Grines The Case for Community Hospital Angioplasty Circulation, November 29, 2005; 112(22): 3509 - 3534. [Full Text] [PDF]
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Part 5: Acute Coronary Syndromes Circulation, November 29, 2005; 112(22_suppl): III-55 - III-72. [Full Text] [PDF]
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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]
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K. Huber, R. D. Caterina, S. D. Kristensen, F. W.A. Verheugt, G. Montalescot, L. B. Maestro, F. V. d. Werf, and for the Task Force on Pre-hospital Reperfusion The Pre-hospital reperfusion therapy: a strategy to improve therapeutic outcome in patients with ST-elevation myocardial infarction Eur. Heart J., October 1, 2005; 26(19): 2063 - 2074. [Full Text] [PDF]
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D. J. Magid, Y. Wang, J. Herrin, R. L. McNamara, E. H. Bradley, J. P. Curtis, C. V. Pollack Jr, W. J. French, M. E. Blaney, and H. M. Krumholz Relationship Between Time of Day, Day of Week, Timeliness of Reperfusion, and In-Hospital Mortality for Patients With Acute ST-Segment Elevation Myocardial Infarction JAMA, August 17, 2005; 294(7): 803 - 812. [Abstract] [Full Text] [PDF]
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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]
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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]
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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]
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W. W. O'Neill, S. R. Dixon, and C. L. Grines The year in interventional cardiology J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1117 - 1134. [Full Text] [PDF]
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C. J. Terkelsen, J. F. Lassen, B. L. Norgaard, J. C. Gerdes, S. H. Poulsen, K. Bendix, J. P. Ankersen, L. B.-H. Gotzsche, F. K. Romer, T. T. Nielsen, et al. Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutanous coronary intervention Eur. Heart J., April 2, 2005; 26(8): 770 - 777. [Abstract] [Full Text] [PDF]
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