Importance of time-to-reperfusion in patients with acute myocardial infarction with and without cardiogenic shock treated with primary percutaneous coronary intervention

Brodie, Bruce R.; Stuckey, Thomas; Muncy, Denise; Hansen, C.; Wall, Thomas C.; Pulsipher, Mark; Gupta, Navin

doi:10.1067/mhj.2003.9

Cited by 87 publications

(53 citation statements)

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“…These data have been strongly supported by recent reports. 6,7 A major limitation of the study by Cannon et al 4 is that very long door-to-balloon time (Ͼ2 hours) was observed in up to 50% of patients, which may affect the relationship between time delay and mortality. This confounding mechanism does not play a major role in single-center studies.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7] In a pooled analysis of all randomized trials that compared thrombolysis and primary angioplasty, Zijlstra et al 3 found that mortality linearly increased with time delay only in patients treated by thrombolysis, whereas it was relatively stable in patients treated by primary angioplasty. Cannon et al, 4 in a cohort of 27 080 patients undergoing primary angioplasty, found that only door-to-balloon time and not symptom onset-toballoon time was associated with mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Although primary angioplasty, in comparison with thrombolysis, may guarantee a higher rate of reperfusion in patients presenting late, it cannot prevent myocardial necrosis, which is related to the duration of occlusion, particularly in higher-risk patients. [5][6][7] …”

Section: Patient Characteristics and Ischemic Timementioning

confidence: 99%

“…[3][4][5][6] In a recent study, 7 we have shown that time from symptom onset to balloon inflation, but not door-to-balloon time, is strongly related to 1-year mortality in patients treated by primary angioplasty. 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 in treatment.…”

mentioning

confidence: 99%

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Time Delay to Treatment and Mortality in Primary Angioplasty for Acute Myocardial Infarction

et al. 2004

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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 Ͼ70 years (PϽ0.0001), female gender (Pϭ0.004), presence of diabetes mellitus (Pϭ0.002), and previous revascularization (Pϭ0.035). Patients with successful reperfusion had a significantly shorter ischemic time (Pϭ0.006). 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; Pϭ0.041). 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patient Characteristics and Ischemic Timementioning

confidence: 99%

mentioning

confidence: 99%

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Time Delay to Treatment and Mortality in Primary Angioplasty for Acute Myocardial Infarction

et al. 2004

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“…It is clear that the duration of ischemia time is inversely related to the size of myocardial infarciton. Indeed, it seems that duration of ischemia time can be critical in high risk patients with large ischemia as supported with correlation between ishemia time and in-hospital mortality in studies with high-risk patients [23,27,28]. In addition to strong relationship between door to balloon time and in-hospital mortality, evidence further suggests that there is increased risk for in-hospital mortality when this time is longer than 2 hours [24].…”

Section: Ischemia Time and Door To Balloon Timementioning

confidence: 91%

Predictors of In-Hospital Mortality in Patients with Acute Inferior Infarction of the Left Ventricle Accompanied by Right Ventricular Infarction when Treated with Percutaneous Coronary Intervention

Ninkovic¹,

Perunicic²

2013

J Clin Exp Cardiolog

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Introduction: Right ventricular infarction (RVI) significantly increases the risk of in-hospital mortality in patients with acute inferior infarction of the left ventricle (AIILV). The present study evaluated pre-procedural and intra-procedural predictors of in-hospital mortality in patients with AIILV, accompanied by right RVI, when treated with primary percutaneous coronary intervention (PCI).Methods: 237 patients with acute inferior infarction of the left ventricle accompanied with RVI and treated with PCI were admitted to the Coronary Care Unit at Clinical Centre of Serbia, from 2007 until 2009. In-hospital mortality was 4.2%. Results: Using a multivariate logistic regression model, two independent risk-factors for in-hospital mortality were identified: cardiogenic shock caused by right ventricular insufficiency (54.5% vs. 4.5% without cardiogenic shock, p=0.002) and post-procedural TIMI flow <3 (50.0% with TIMI flow <3 vs. 5.6% with TIMI flow 3, p=0.026). In the group of patients without cardiogenic shock, independent risk-factors of inhospital mortality were Killip class >1 (p = 0.019) and previous PCI (p=0.021). Conclusions and clinical implications:Cardiogenic shock and post-procedural TIMI flow <3 in the infarcted artery are independent predictors of in-hospital mortality. In patients without cardiogenic shock, the risk for in-hospital mortality correlates with the degree of left ventricular insufficiency and previous PCI.

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Trends in Door-to-Balloon Time and Mortality in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Flynn¹,

Moscucci²,

Share³

et al. 2010

Arch Intern Med

128

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Importance of time-to-reperfusion in patients with acute myocardial infarction with and without cardiogenic shock treated with primary percutaneous coronary intervention

Cited by 87 publications

References 0 publications

Time Delay to Treatment and Mortality in Primary Angioplasty for Acute Myocardial Infarction

Time Delay to Treatment and Mortality in Primary Angioplasty for Acute Myocardial Infarction

Predictors of In-Hospital Mortality in Patients with Acute Inferior Infarction of the Left Ventricle Accompanied by Right Ventricular Infarction when Treated with Percutaneous Coronary Intervention

Trends in Door-to-Balloon Time and Mortality in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

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