| Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction: results from the global use of strategies to open occluded arteries in Acute Coronary Syndromes (GUSTO-IIb) trial. | |
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MedLine Citation:
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PMID: 10393675 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 (n=565) 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 </=60 minutes after study enrollment was 1.0%; 61 to 75 minutes after enrollment, 3.7%; 76 to 90 minutes after enrollment, 4.0%; and >/=91 minutes after enrollment, 6.4%. The mortality rate of patients assigned to angioplasty who never underwent the procedure was 14.1% (P=0.001). 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 (P=0.008) 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. |
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Authors:
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P B Berger; S G Ellis; D R Holmes; C B Granger; D A Criger; A Betriu; E J Topol; R M Califf |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial |
Journal Detail:
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Title: Circulation Volume: 100 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 1999 Jul |
Date Detail:
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Created Date: 1999-07-16 Completed Date: 1999-07-16 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 14-20 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. berger.peter@mayo.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Angioplasty, Transluminal, Percutaneous Coronary / statistics & numerical data* Anticoagulants / therapeutic use Combined Modality Therapy Double-Blind Method Female Heparin / therapeutic use Hirudin Therapy Humans Male Middle Aged Multivariate Analysis Myocardial Infarction / drug therapy, mortality, therapy* Thrombolytic Therapy Time Factors Tissue Plasminogen Activator / therapeutic use Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 9005-49-6/Heparin; EC 3.4.21.68/Tissue Plasminogen Activator |
| Comments/Corrections | |
Comment In:
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Circulation. 2000 May 30;101(21):E211-2
[PMID:
10831539
]
Circulation. 2000 Jul 25;102(4):E29-30 [PMID: 10908227 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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