PT  - JOURNAL ARTICLE
AU  - B Nallamothu
AU  - K A A Fox
AU  - B M Kennelly
AU  - F Van de Werf
AU  - J M Gore
AU  - P G Steg
AU  - C B Granger
AU  - O H Dabbous
AU  - E Kline-Rogers
AU  - K A Eagle
TI  - Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events
AID  - 10.1136/hrt.2006.112847
DP  - 2007 Dec 01
TA  - Heart
PG  - 1552--1555
VI  - 93
IP  - 12
4099  - http://heart.bmj.com/content/93/12/1552.short
4100  - http://heart.bmj.com/content/93/12/1552.full
SO  - Heart2007 Dec 01; 93
AB  - 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.