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Delay in Presentation and Reperfusion Therapy in ST-Elevation Myocardial Infarction
- Source :
-
American Journal of Medicine . Apr2008, Vol. 121 Issue 4, p316-323. 8p. - Publication Year :
- 2008
-
Abstract
- Abstract: Background: We studied the relationship between longer delays from symptom onset to hospital presentation and the use of any reperfusion therapy, door-to-balloon time, and door-to-drug time. Methods: Cohort study of patients with ST-elevation myocardial infarction enrolled in the National Registry of Myocardial Infarction from January 1, 1995 to December 31, 2004. Delay in hospital presentation was categorized into 1-hour intervals as ≤1 hour, >1-2 hours, >2-3 hours, etc, up to >11-12 hours. The study analyzed 3 groups: 440,398 patients for the association between delay and use of any reperfusion therapy; 67,207 patients for the association between delay and door-to-balloon time; 183,441 patients for the association between delay and door-to-drug time. Results: In adjusted analyses, patients with longer delays between symptom onset and hospital presentation were less likely to receive any reperfusion therapy, had longer door-to-balloon times, and had longer door-to-needle times (all P <.0001 for linear trend). For patients presenting ≤1 hour, >1-2 hours, >2-3 hours, >9-10 hours, >10-11 hours, and >11-12 hours after symptom onset, the use of any reperfusion therapy were 77%, 77%, 73%, 53%, 50%, and 46%, respectively. Door-to-balloon times were 99, 101, 106, 123, 125, and 123 minutes, respectively, and door-to-drug times were 33, 34, 36, 46, 44, and 47 minutes, respectively. Conclusions: Longer delays from symptom onset to hospital presentation were associated with reduced likelihood of receiving primary reperfusion therapy, and even among those treated, late presenters had significantly longer door-to-balloon and door-to-drug times. [Copyright &y& Elsevier]
- Subjects :
- *TREATMENT of reperfusion injuries
*MYOCARDIAL infarction
*RANDOMIZED controlled trials
*SYMPTOMS
*MYOCARDIAL infarction treatment
*COMPARATIVE studies
*ELECTROCARDIOGRAPHY
*EMERGENCY medical services
*HOSPITAL emergency services
*LONGITUDINAL method
*RESEARCH methodology
*MEDICAL cooperation
*MULTIVARIATE analysis
*MYOCARDIAL revascularization
*PROBABILITY theory
*RESEARCH
*SURVIVAL analysis (Biometry)
*THROMBOLYTIC therapy
*TIME
*TRANSLUMINAL angioplasty
*EVALUATION research
*TREATMENT effectiveness
*ACQUISITION of data
*RETROSPECTIVE studies
*EARLY diagnosis
*HOSPITAL mortality
*ODDS ratio
MYOCARDIAL infarction diagnosis
MYOCARDIAL infarction-related mortality
Subjects
Details
- Language :
- English
- ISSN :
- 00029343
- Volume :
- 121
- Issue :
- 4
- Database :
- Academic Search Index
- Journal :
- American Journal of Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 31533285
- Full Text :
- https://doi.org/10.1016/j.amjmed.2007.11.017