Heart 2000;84:142-148 ( August )

Cardiovascular medicine

The impact of time to thrombolytic treatment on outcome in patients with acute myocardial infarction P Chareonthaitawee^a, R J Gibbons^a, R S Roberts^b, T F Christian^a, R Burns^c, S Yusuf^d, for the CORE investigators

^a Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA, ^b Hamilton Civic Hospital Research Centre, Hamilton, Ontario, Canada, ^c Nuclear Cardiology Laboratory, The Toronto Hospital, Toronto, Ontario, Canada, ^d Hamilton General Hospital-McMaster Clinic, Hamilton, Ontario, Canada

Correspondence to: Dr P Chareonthaitawee, MRC Cyclotron Unit, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK. email: panithaya.chareonthaitawee{at}csc.mrc.ac.uk

Accepted 29 February 2000

OBJECTIVESTo examine the impact of time to thrombolytic treatment on multiple acute outcome variables in a single trial of thrombolysis in acute myocardial infarction.
DESIGN AND PATIENTSMortality and reinfarction rate were measured in 2770 patients with acute myocardial infarction who received thrombolysis within 12 hours in CORE, an international, dose ranging trial of poloxamer 188. Tc-99m sestamibi infarct size and radionuclide angiographic ejection fraction substudies included 1099 and 1074 patients, respectively.
RESULTSTime to thrombolysis, subgrouped by intervals (< 2, 2-4,  4-6, and  6 hours), was significantly associated with infarct size (median 15.0%, 18.5%, 22.0%, 18.5% of left ventricle; p = 0.033), mean (SD) ejection fraction (51.5 (12.0)%, 48.3 (13.9)%, 48.2 (13.3)%, 48.2 (15.0)%; p = 0.006), 35 day mortality (5.7%, 7.1%, 7.9%, 12.5%; p = 0.0004), six month mortality (7.3%, 8.6%, 10.4%, 15.5%; p < 0.0001), and 35 day reinfarction rate (6.1%, 3.2%, 4.0%, 0.9%; p = 0.0001).
CONCLUSIONSIn this single large trial, the beneficial effect of time to thrombolysis on infarct size and ejection fraction was restricted to treatment given within two hours of symptom onset, while the effect on mortality was evident over all time intervals. Reinfarction rate was higher in patients treated with earlier thrombolysis.


Keywords: myocardial infarction; thrombolysis; infarct size

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© 2000 by Heart
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