Clinical outcomes according to time to treatment

Clinical Cardiology
K Newby

Abstract

Twenty years ago, pathophysiologic studies showed that myocardial salvage in acute myocardial infarction depends on early intervention. A meta-analysis of the largest thrombolytic trials showed 1.6 lives saved/1000 treated for each hour closer to symptom onset, and that patients treated in the first hour have a much higher survival rate. The MITI trial found a seven-fold decrease in mortality in patients treated within 70 min of symptom onset. The GUSTO study showed similar results, except that during the first hour mortality was actually higher than in the second hour. In contrast, studies have found that while little survival benefit accrues from treatment after a 12 h delay, significant benefit is achieved by treatment between 6 and 12 h from symptom onset. Thus, mechanisms other than myocardial salvage are at work. A GUSTO substudy demonstrated considerable in-hospital delays in attaining electrocardiographic readings, in deciding on the course of therapy, and most of all in the time to infuse the drug. Other delays in both presentation and treatment are related to patient characteristics such as age, gender, diabetes, and Killip class. The medical community cannot control delays in presentation, but it has been able to red...Continue Reading

References

Jul 1, 1995·Perfusion·D A Palanzo, F S Sadr
Jun 1, 1996·Journal of the American College of Cardiology·L K NewbyF Van de Werf
Dec 19, 1996·The American Journal of Cardiology·R M Califf, L K Newby

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Citations

Jan 10, 1998·Clinical Cardiology·W E Moore
Jan 5, 2002·Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology·J RuefC Bode
Aug 26, 2004·The Journal of Cardiovascular Nursing·Leanne L Lefler, Kathleen N Bondy
Apr 10, 2013·The Journal of International Medical Research·Xueling Wang, Lily Lihwa Hsu
Apr 9, 2015·European Journal of Cardiovascular Nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology·Sheila O'Keefe-McCarthyJudith McFetridge-Durdle
Feb 29, 2008·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Bertrand RenaudEric Roupie
Jun 26, 2007·The Journal of Cardiovascular Nursing·Debra K MoserUNKNOWN American Heart Association Council on Cardiovascular Nursing and Stroke Council

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