Interventional Cardiology
Impact of prehospital delay on mortality in patients with acute myocardial infarction treated with primary angioplasty and intravenous thrombolysis,☆☆

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Abstract

Background In patients with acute myocardial infarction treated with thrombolysis, longer times to treatment are associated with increasingly worse clinical outcome. This relation may be different for treatment with primary angioplasty. Methods We analyzed the pooled data of the German acute myocardial infarction registries Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) and Myocardial Infarction Registry (MIR) to determine the influence of prehospital delays on hospital mortality rates. Primary angioplasty was performed in 1063 patients and thrombolysis in 7552 patients. Results In patients treated with thrombolysis, in-hospital time to treatment was constantly 30 minutes median. In patients treated with primary angioplasty, in-hospital time to treatment increased from 60 minutes median up to 87 minutes median with increasing prehospital delay. Hospital mortality rates slightly decreased with increasing prehospital delays in patients treated with primary angioplasty (P for trend =.02). However, in patients treated with thrombolysis, mortality rate was nonsignificantly increased (P for trend =.11). Logistic regression analysis showed no significant difference in mortality rates between primary angioplasty and thrombolysis for prehospital delays of <3 hours. However, when prehospital delay was >3 hours, thrombolysis was independently associated with a higher mortality rate compared with primary angioplasty. Conclusions Compared with thrombolysis, primary angioplasty is independently associated with a lower mortality rate in prehospital delays of >3 hours. The reason for this may be a time-dependent loss of efficacy to achieve reperfusion for thrombolysis but not for primary angioplasty. (Am Heart J 2001;142:105-11.)

Section snippets

Methods

The MITRA study and the MIR were German prospective, multicenter, observational studies of the current treatment of AMI. The MITRA study recruited patients between June 1994 and January 1997. Fifty-four hospitals, mainly located in the Southwest of Germany, including university hospitals, tertiary care centers, and smaller hospitals, participated in the study. The MIR study was a nationwide registry, which included patients from December 1996 to May 1998. A total of 217 hospitals, mainly

Results

From 1994 to 1998, 22,749 patients with AMI were registered by the MITRA and MIR registries. Primary angioplasty was performed in 1063 patients, and 7552 patients were treated with thrombolysis.

Selected patient characteristics for the different prehospital delays according to type of treatment are shown in Table I.

. Characteristics of patients with acute myocardial infarction according to prehospital delays in patients treated with primary angioplasty compared with patients treated with

Discussion

The pooled data of the MITRA and MIR registries show that in patients with AMI treated with primary angioplasty, longer prehospital delays were followed by longer in-hospital times to treatment. Longer prehospital delays, and therefore longer times to treatment, were associated with a slightly decreasing mortality rate in patients treated with primary angioplasty. This is in contrast to the nonsignificantly increased mortality rate with increased prehospital delays in patients treated with

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  • Cited by (0)

    Supported in part by AstraZeneca, Bristol Myers-Squibb, Ministerium für Gesundheit, Arbeit, Soziales des Landes Rheinland-Pfalz, Landesversicherungsanstalt Rheinland-Pfalz, Barmer, and Betriebskrankenkassen Rheinland-Pfalz.

    ☆☆

    Reprint requests: Ralf Zahn, MD, Herzzentrum Ludwigshafen, Department of Cardiology; Bremserstrasse 79, D–67063 Ludwigshafen, Germany. E-mail: [email protected]

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