TY - JOUR
T1 - Clinical characteristics and outcome of patients with early (<2 h), intermediate (2-4 h) and late (>4 h) presentation treated by primary coronary angioplasty or thrombolytic therapy for acute myocardial infarction
AU - Zijlstra, Felix
AU - Patel, A.
AU - Jones, M.
AU - Grines, C. L.
AU - Ellis, S.
AU - Garcia, E.
AU - Grinfeld, L.
AU - Gibbons, R. J.
AU - Ribeiro, E. E.
AU - Ribichini, F.
AU - Granger, C.
AU - Akhras, F.
AU - Weaver, W. D.
AU - Simes, R. J.
PY - 2002/4
Y1 - 2002/4
N2 - Aims: We examined the clinical characteristics and outcome of patients with early (<2 h), intermediate (2-4 h) and late (>4 h) presentation treated by primary angioplasty or thrombolytic therapy for acute myocardial infarction. Methods and Results: We studied 2635 patients enrolled in 10 randomized trials of primary angioplasty (n = 1302) vs thrombolytic therapy (n = 1333) in acute myocardial infarction, and baseline characteristics of the two groups were comparable. Increase in presentation delay is associated with older age, female gender, diabetes and an increased heart rate. We classified the patients according to the time delay from symptom onset to presentation into three categories: early presentation (<2 h), intermediate presentation (2-4 h), and late presentation (≥4 h). At 30 days the combined rate of death, non-fatal reinfarction and stroke in patients presenting early was 5.8% in the angioplasty group vs 12.5% in the thrombolysis group, in patients with intermediate presentation, 8.6% vs 14.2%, respectively, and in patients presenting late 7.7% vs 19.4%, respectively. With increasing time from symptom onset to presentation, all major adverse cardiac event rates show a trend to a larger increase in the thrombolysis group compared to the angioplasty group, both at 30 days and at 6 months after the acute event. Conclusions: Major adverse cardiac event rates are lower after angioplasty compared to thrombolysis, irrespective of time to presentation. With increasing time to presentation major adverse cardiac event rates increase after thrombolysis but appear to remain relatively stable after angioplasty.
AB - Aims: We examined the clinical characteristics and outcome of patients with early (<2 h), intermediate (2-4 h) and late (>4 h) presentation treated by primary angioplasty or thrombolytic therapy for acute myocardial infarction. Methods and Results: We studied 2635 patients enrolled in 10 randomized trials of primary angioplasty (n = 1302) vs thrombolytic therapy (n = 1333) in acute myocardial infarction, and baseline characteristics of the two groups were comparable. Increase in presentation delay is associated with older age, female gender, diabetes and an increased heart rate. We classified the patients according to the time delay from symptom onset to presentation into three categories: early presentation (<2 h), intermediate presentation (2-4 h), and late presentation (≥4 h). At 30 days the combined rate of death, non-fatal reinfarction and stroke in patients presenting early was 5.8% in the angioplasty group vs 12.5% in the thrombolysis group, in patients with intermediate presentation, 8.6% vs 14.2%, respectively, and in patients presenting late 7.7% vs 19.4%, respectively. With increasing time from symptom onset to presentation, all major adverse cardiac event rates show a trend to a larger increase in the thrombolysis group compared to the angioplasty group, both at 30 days and at 6 months after the acute event. Conclusions: Major adverse cardiac event rates are lower after angioplasty compared to thrombolysis, irrespective of time to presentation. With increasing time to presentation major adverse cardiac event rates increase after thrombolysis but appear to remain relatively stable after angioplasty.
KW - Coronary angioplasty
KW - Myocardial infarction
KW - Thrombolytic therapy
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U2 - 10.1053/euhj.2001.2901
DO - 10.1053/euhj.2001.2901
M3 - Article
C2 - 11922645
AN - SCOPUS:0036554790
SN - 0195-668X
VL - 23
SP - 550
EP - 557
JO - European heart journal
JF - European heart journal
IS - 7
ER -