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Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events
  1. Brahmajee Nallamothu (bnallamo{at}med.umich.edu)
  1. VA Health Services Research & Development Center of Excellence, United States
    1. Keith AA Fox (k.a.a.fox{at}ed.ac.uk)
    1. University of Edinburgh, United Kingdom
      1. Brian M Kennelly (lumreek{at}aol.com)
      1. Hoag Memorial Hospital Presbyterian, United States
        1. Frans Van de Werf (frans.vandewerf{at}uz.kuleuven.ac.be)
        1. Gasthuisberg University Hospital, Belgium
          1. Joel M Gore (gorej{at}ummhc.org)
          1. University of Massachusetts Medical School, United States
            1. Ph. Gabriel Steg (gabriel.steg{at}bch.aphp.fr)
            1. Hopital Bichat, France
              1. Christopher B Granger (christopher.granger{at}duke.edu)
              1. Duke University Medical Center, United States
                1. Omar H Dabbous (omar.dabbous{at}gmail.com)
                1. University of Massachusetts Medical School, United States
                  1. Eva Kline-Rogers (evakline{at}med.umich.edu)
                  1. University of Michigan Medical School, United States
                    1. Kim A Eagle (keagle{at}med.umich.edu)
                    1. University of Michigan Cardiovascular Center, United States

                      Abstract

                      Objective Treatment delays may result in different clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who receive fibrinolytic therapy versus primary percutaneous coronary intervention (PCI). The aim of this analysis was to examine how treatment delays relate to 6-month mortality in reperfusion-treated patients enrolled in the Global Registry of Acute Coronary Events (GRACE).

                      Design Prospective, observational cohort study.

                      Setting 106 hospitals in 14 countries.

                      Patients 3959 patients who presented with STEMI within 6 h of symptom onset and received reperfusion with either a fibrin-specific fibrinolytic drug or primary PCI. Main outcome measures: Six-month mortality.

                      Methods Multivariable logistic regression was used to assess the relationship between outcomes and treatment delay separately in each cohort, with time modeled with a quadratic term after adjusting for covariates from the GRACE risk score.

                      Results A total of 1786 (45.1%) patients received fibrinolytic therapy and 2173 (54.9%) underwent primary PCI. After multivariable adjustment, longer treatment delays were associated with higher 6-month mortality in both fibrinolytic therapy and primary PCI patients (p < 0.001 for both cohorts). For patients who received fibrinolytic therapy, 6-month mortality increased by 0.30% per 10-min delay in door-to-needle time between 30 and 60 min compared with 0.18% per 10-min delay in door-to-balloon time between 90 and 150 min for patients undergoing primary PCI.

                      Conclusions Treatment delays in reperfusion therapy are associated with higher 6-month mortality, but this relationship may be even more critical in patients receiving fibrinolytic therapy.

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