Document Detail


Symptom-onset-to-balloon time and mortality in patients with acute myocardial infarction treated by primary angioplasty.
MedLine Citation:
PMID:  13678918     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of the study was to evaluate the relationship between symptom-onset-to-balloon time and one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary angioplasty. BACKGROUND: Despite the prognostic implications demonstrated in patients with STEMI treated with thrombolysis, the impact of time-delay on prognosis in patients undergoing primary angioplasty has yet to be established. METHODS: Our study population consisted of 1,791 patients with STEMI treated by primary angioplasty from 1994 to 2001. All clinical, angiographic and follow-up data were collected. Subanalyses were conducted according to patient risk profile at presentation and preprocedural Thrombolysis In Myocardial Infarction (TIMI) flow. RESULTS: A total of 103 patients (5.8%) had died at one year. Symptom-onset-to-balloon time was significantly associated with the rate of postprocedural TIMI 3 flow (p = 0.012), myocardial blush grade (p = 0.033), and one-year mortality (p = 0.02). A stronger linear association between symptom-onset-to-balloon time and one-year mortality was observed in non-low-risk patients (p = 0.006) and those with preprocedural TIMI flow 0 to 1 (p = 0.013). No relationship was found between door-to-balloon time and mortality. At multivariate analysis, a symptom-onset-to-balloon time >4 h was identified as an independent predictor of one-year mortality (p < 0.05). CONCLUSIONS: This study shows that, in patients with STEMI treated by primary angioplasty, symptom-onset-to-balloon time, but not door-to-balloon time, is related to mortality, particularly in non-low-risk patients and in the absence of preprocedural anterograde flow. Furthermore, a symptom-onset-to-balloon time >4 h was identified as independent predictor of one-year mortality.
Authors:
Giuseppe De Luca; Harry Suryapranata; Felix Zijlstra; Arnoud W J van 't Hof; Jan C A Hoorntje; A T Marcel Gosselink; Jan Henk Dambrink; Menko Jan de Boer;
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  42     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-09-18     Completed Date:  2003-11-03     Revised Date:  2007-09-04    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  991-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, ISALA Klinieken, Hospital De Weezenlanden, Zwolle, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary*
Female
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis,  mortality*,  therapy*
Time Factors
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2006 Sep 5;48(5):1062; author reply 1062-3   [PMID:  16949510 ]

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