Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2007 Dec;93(12):1552-5.
doi: 10.1136/hrt.2006.112847. Epub 2007 Jun 25.

Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events

B Nallamothu  1 , K A A Fox, B M Kennelly, F Van de Werf, J M Gore, P G Steg, C B Granger, O H Dabbous, E Kline-Rogers, K A Eagle; GRACE Investigators
Affiliations
Multicenter Study

Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events

B Nallamothu et al. Heart. 2007 Dec.

Abstract

Objective: Treatment delays may result in different clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who receive fibrinolytic therapy vs primary percutaneous coronary intervention (PCI). The aim of this analysis was to examine how treatment delays relate to 6-month mortality in reperfusion-treated patients enrolled in the Global Registry of Acute Coronary Events (GRACE).

Design: Prospective, observational cohort study.

Setting: 106 hospitals in 14 countries.

Patients: 3959 patients who presented with STEMI within 6 h of symptom onset and received reperfusion with either a fibrin-specific fibrinolytic drug or primary PCI.

Main outcome measures: 6-month mortality.

Methods: Multivariable logistic regression was used to assess the relationship between outcomes and treatment delay separately in each cohort, with time modelled with a quadratic term after adjusting for covariates from the GRACE risk score.

Results: A total of 1786 (45.1%) patients received fibrinolytic therapy, and 2173 (54.9%) underwent primary PCI. After multivariable adjustment, longer treatment delays were associated with a higher 6-month mortality in both fibrinolytic therapy and primary PCI patients (p<0.001 for both cohorts). For patients who received fibrinolytic therapy, 6-month mortality increased by 0.30% per 10-min delay in door-to-needle time between 30 and 60 min compared with 0.18% per 10-min delay in door-to-balloon time between 90 and 150 min for patients undergoing primary PCI.

Conclusions: Treatment delays in reperfusion therapy are associated with higher 6-month mortality, but this relationship may be even more critical in patients receiving fibrinolytic therapy.

PubMed Disclaimer

Conflict of interest statement

Competing interests: B K Nallamothu: none. K A A Fox: British Heart foundation, Medical Research Council, The Wellcome Trust, Aventis, Sanofi Synthelabo, GlaxoSmithKline, Bristol‐Myers Squibb. B M Kennelly: sanofi‐aventis. F Van de Werf: sanofi‐aventis. J M Gore: sanofi‐aventis. P G Steg: Speakers bureau; Boehringer‐Ingelheim, BMS, GSK, MSD, Novartis, Nycomed, sanofi‐aventis, Sankyo, Servier, ZLB‐Behring. Consulting/advisory board: AstraZeneca, BMS, GSK, MSD, Pfizer, sanofi‐aventis, Servier, Takeda. Stockholding: none. C B Granger: sanofi‐aventis, Procter and Gamble, Alexion, Bristol‐Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, Novartis, The Medicines Company. O H Dabbous: none. E Kline‐Rogers: none. K A Eagle: Biosite, Bristol Myers Squibb, Cardiac Sciences, Blue Cross Blue Shield of Michigan, Hewlett Foundation, Mardigian Fund, Pfizer, sanofi‐aventis, Varbedian fund, National Heart, Lung & Blood NIH.

References

    1. Boersma E, Maas A C, Deckers J W.et al Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet 1996348771–775. - PubMed
    1. Cannon C P, Gibson C M, Lambrew C T.et al Relationship of symptom‐onset‐to‐balloon time and door‐to‐balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA 20002832941–2947. - PubMed
    1. Giugliano R P, Braunwald E. Selecting the best reperfusion strategy in ST‐elevation myocardial infarction: it's all a matter of time. Circulation 20031082828–2830. - PubMed
    1. Betriu A, Masotti M. Comparison of mortality rates in acute myocardial infarction treated by percutaneous coronary intervention versus fibrinolysis. Am J Cardiol 200595100–101. - PubMed
    1. Boersma E. 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 200627779–788. - PubMed

Publication types