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Impact of the time to reperfusion on early outcomes in patients with acute myocardial infarction undergoing primary angioplasty.

Abstract：

BACKGROUND:The ACC/AHA guidelines for management of patients with ST-elevation myocardial infarction (STEMI) have recommended primary PCI (pPCI) as the preferred reperfusion therapy, when it can be performed in a timely fashion, within 90-110 min from the first contact with medical personnel. The impact of treatment delays on outcomes in patients undergoing pPCI has been controversial. AIM:To evaluate the impact of time delays on in-hospital mortality and on the frequency of cardiac events during 30 days after STEMI. METHODS:1723 patients were stratified on the basis of their time delays: from symptom onset until balloon inflation. The patients were divided into 4 groups: group 1 (311 patients) - time from symptom onset <90 min; group 2 (731 patients) - time delays of 90-180 min; group 3 (535 patients) - time delays of 180-360 min, and group 4 (146 patients) - time from symptom onset >360 min. RESULTS:The median time delay was 268.5+/-206 min, the median door to balloon time was 36.12+/-11.2 min. The patients with longer time delays (group 4) were older, more often were women, and had a higher frequency of diabetes, anterior MI and Killip class 4. During hospitalisation, 70 (4.1%) patients died. In-hospital mortality was significantly higher in group 4 (13.6%) than in other groups. Complications of STEMI such as cardiogenic shock considerably influenced mortality (45.6%). During a 30-day follow- -up, the patients with cardiogenic shock and the elderly had an increased risk of cardiac events. Also, time delays >360 min and failed pPTCA were independent adverse risk factors in multivariate regression analysis. CONCLUSION:Delays in time to pPCI have an impact on outcomes, especially in those treated >6 hours from the onset of symptoms.

journal_name

Kardiol Pol

journal_title

Kardiologia polska

authors

Trzos E,Kurpesa M,Bednarkiewicz Z,Peruga J,Kasprzak J,Plewka M,Uznańska B,Krzemińska-Pakuła M

subject

Has Abstract

pub_date

2007-11-01 00:00:00

pages

1296-304; discussion 1305-6

issue

eissn

0022-9032

issn

1897-4279

pii

9327

journal_volume

pub_type

临床试验,杂志文章

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Impact of the time to reperfusion on early outcomes in patients with acute myocardial infarction undergoing primary angioplasty.