Relationship Between Delay in Performing Direct Coronary Angioplasty and Early Clinical Outcome in Patients With Acute Myocardial Infarction

Abstract

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 (nϭ565) 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 Յ60 minutes after study enrollment was 1.0%; 61 to 75 minutes after enrollment, 3.7%; 76 to 90 minutes after enrollment, 4.0%; and Ն91 minutes after enrollment, 6.4%. The mortality rate of patients assigned to angioplasty who never underwent the procedure was 14.1% (Pϭ0.001). 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 (Pϭ0.008) 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.

Impact of a single universal guiding catheter on door-to-balloon time in primary transradial coronary intervention for ST segment elevation myocardial infarction

“…Shorter doorto-balloon (D2B) time has strong association with a lower mortality rate [3][4][5]. Based on these data, a D2B time of \90 min has been established as a Class I recommendation in the current guidelines [6,7].…”

Predicting 30‐Day Hospital Readmissions in Acute Myocardial Infarction: The AMI “READMITS” (Renal Function, Elevated Brain Natriuretic Peptide, Age, Diabetes Mellitus , Nonmale Sex , Intervention with Timely Percutaneous Coronary Intervention, and Low Systolic Blood Pressure) Score

“…Third, our study population was derived from 6 hospitals diverse in payer status, age, race/ethnicity, and socioeconomic status, increasing the potential generalizability of our findings. Fourth, our models are less likely to be overfit to the idiosyncrasies of our data given that the predictors in our final AMI‐specific models have good clinical face validity, and have been associated with adverse outcomes, particularly mortality, in prior studies of this population 28, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39…”

402 Sex Preferences in Cardiovascular Testing: The Contribution of the Patient-Physician Discussion

“…Even if we assume all recommendations regarding further testing were appropriately tailored to the patients' risk for ACS, education and increased awareness are relatively efficient, inexpensive modalities to improve CAD-related outcomes. While public awareness campaigns have shown to be an ineffective means of improving the delay to treatment in ACS, women have been substantially under-represented in these studies, [36][37][38][39] and no study to our knowledge has looked specifically at one-on-one, physician-directed education as a public awareness intervention.…”