Association of duration of symptoms at presentation with angiographic and clinical outcomes after fibrinolytic therapy in patients with ST-segment elevation myocardial infarction

Journal of the American College of Cardiology
C M GibsonTIMI Study Group

Abstract

We sought to determine if an underlying mechanism of the association between prolonged symptom-to-treatment times and adverse outcomes may be an association of symptom-to-treatment times with impaired Thrombolysis In Myocardial Infarction myocardial perfusion grades (TMPGs). Prolonged symptom duration among ST-segment elevation myocardial infarction (STEMI) patients undergoing fibrinolytic therapy is associated with adverse outcomes. Angiography was performed 60 min after fibrinolytic administration in 3,845 Thrombolysis In Myocardial Infarction (TIMI) trial patients. The median time from symptom onset to treatment was longer among patients with impaired myocardial perfusion (3.0 h for TMPG 0/1 vs. 2.7 h for TMPG 2/3; p = 0.001). In a multivariate model, impaired tissue perfusion (TMPG 0/1) remained associated with increased time to treatment (odds ratio 1.14 per hour of delay; p = 0.007) even after adjusting for Thrombolysis In Myocardial Infarction flow grade (TFG) 3, left anterior descending infarct location, and baseline clinical characteristics. Impaired myocardial perfusion after rescue/adjunctive percutaneous coronary intervention (PCI) was associated with longer median times to treatment (3.0 h for TMPG 2/3 vs. 2.7 h fo...Continue Reading

References

Dec 8, 2000·Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology·G Bernardi
Sep 19, 2003·Journal of the American College of Cardiology·Giuseppe De LucaUNKNOWN ZWOLLE Myocardial Infarction Study Group

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Citations

Apr 11, 2009·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·John KanakakisMaria Anastasiou-Nana
Sep 18, 2008·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Vinod JorapurG B John Mancini
Apr 1, 2008·The American Journal of Medicine·Henry H TingHarlan M Krumholz
Oct 9, 2007·The American Journal of Cardiology·Robert L McNamaraHarlan M Krumholz
Mar 17, 2005·European Heart Journal·Sigmund SilberUNKNOWN Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology

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