Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty
Section snippets
Patients
Since January 1995, primary PTCA has been the standard treatment at our institution for all patients with AMI admitted within 6 hours of symptom onset, and for those admitted within 24 hours with evidence of continuing ischemia, without any restriction based on age, sex, or clinical status on presentation. The exclusion criteria for this study were: (1) previous fibrinolytic treatment, and (2) inabilty to provide informed consent. Angiographic criteria for exclusion from intervention were: (1)
Patients and procedural results
Between January 1995 and October 2000, 1,362 consecutive patients with AMI underwent primary mechanical intervention. Of these, 26 (2%) had an unsuccessful procedure and were excluded from the analysis, whereas 1,336 patients had successful procedures. Of the 1,336 patients with successful procedures, 942 (71%) were at not low risk, and 394 (29%) were at low risk. The baseline characteristics of the 2 groups are listed in Table 1. The not low-risk patients were a mean age of 67 ± 12 years; 73%
Discussion
In our study the relation of time to treatment with mortality is evident for not low-risk patients, whereas it is lacking for the low-risk patient subset. These numbers may be easily explained considering that the benefit of treatment is strongly related to patient risk, and it is very difficult or even impossible to show a benefit of a reperfusive treatment for patients with a very low risk of death. For not low-risk patients, mortality increased with longer time to treatment and univariate
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This study was supported by a grant of the A.R. Card. ONLUS Foundation, Florence, Italy.