Article Text

Download PDFPDF
Acute coronary syndromes
Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events
  1. B Nallamothu1,
  2. K A A Fox2,
  3. B M Kennelly3,
  4. F Van de Werf4,
  5. J M Gore5,
  6. P G Steg6,
  7. C B Granger7,
  8. O H Dabbous8,
  9. E Kline-Rogers9,
  10. K A Eagle9
  1. 1
    VA Health Services Research & Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, USA
  2. 2
    Cardiovascular Research, Division of Medical & Radiological Sciences, The University of Edinburgh, Edinburgh, UK
  3. 3
    Department of Cardiology, Hoag Memorial Hospital Presbyterian, Newport Beach, USA
  4. 4
    Department of Cardiology, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
  5. 5
    Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, USA
  6. 6
    Cardiology, Hôpital Bichat, Paris, France
  7. 7
    Duke University Medical Center, Durham, USA
  8. 8
    Center for Outcomes Research, University of Massachusetts Medical School, Worcester, USA
  9. 9
    University of Michigan Medical School, Ann Arbor, USA
  1. Kim A Eagle, University of Michigan Cardiovascular Center, 300 N. Ingalls, 8B02, Ann Arbor, MI 48109-0477, USA; keagle{at}


Objective: Treatment delays may result in different clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who receive fibrinolytic therapy vs 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: 6-month mortality.

Methods: Multivariable logistic regression was used to assess the relationship between outcomes and treatment delay separately in each cohort, with time modelled 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 a 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.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: GRACE is funded by an unrestricted educational grant from sanofi-aventis (Paris, France) to the Center for Outcomes Research, University of Massachusetts Medical School (Worcester, MA).

  • Competing interests: B K Nallamothu: none. K A A Fox: British Heart foundation, Medical Research Council, The Wellcome Trust, Aventis, Sanofi Synthelabo, GlaxoSmithKline, Bristol-Myers Squibb. B M Kennelly: sanofi-aventis. F Van de Werf: sanofi-aventis. J M Gore: sanofi-aventis. P G Steg: Speakers bureau; Boehringer-Ingelheim, BMS, GSK, MSD, Novartis, Nycomed, sanofi-aventis, Sankyo, Servier, ZLB-Behring. Consulting/advisory board: AstraZeneca, BMS, GSK, MSD, Pfizer, sanofi-aventis, Servier, Takeda. Stockholding: none. C B Granger: sanofi-aventis, Procter and Gamble, Alexion, Bristol-Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, Novartis, The Medicines Company. O H Dabbous: none. E Kline-Rogers: none. K A Eagle: Biosite, Bristol Myers Squibb, Cardiac Sciences, Blue Cross Blue Shield of Michigan, Hewlett Foundation, Mardigian Fund, Pfizer, sanofi-aventis, Varbedian fund, National Heart, Lung & Blood NIH.

  • Abbreviations:
    acute coronary syndromes
    Global Registry of Acute Coronary Events
    interquartile range
    percutaneous coronary intervention
    ST-segment elevation myocardial infarction
    Thrombosis in Myocardial Infarction