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

Felix Zijlstra, A. Patel, M. Jones, C. L. Grines, S. Ellis, E. Garcia, L. Grinfeld, R. J. Gibbons, E. E. Ribeiro, F. Ribichini, C. Granger, F. Akhras, W. D. Weaver, R. J. Simes

Research output: Contribution to journalArticle

265 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)550-557
Number of pages8
JournalEuropean heart journal
Volume23
Issue number7
DOIs
StatePublished - Apr 1 2002

Keywords

  • Coronary angioplasty
  • Myocardial infarction
  • Thrombolytic therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Zijlstra, F., Patel, A., Jones, M., Grines, C. L., Ellis, S., Garcia, E., Grinfeld, L., Gibbons, R. J., Ribeiro, E. E., Ribichini, F., Granger, C., Akhras, F., Weaver, W. D., & Simes, R. J. (2002). 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. European heart journal, 23(7), 550-557. https://doi.org/10.1053/euhj.2001.2901