Delay in Presentation and Reperfusion Therapy in ST-Elevation Myocardial Infarction

Henry H. Ting, Elizabeth H. Bradley, Yongfei Wang, Brahmajee K. Nallamothu, Bernard J. Gersh, Veronique Lee Roger, Judith H. Lichtman, Jeptha P. Curtis, Harlan M. Krumholz

Research output: Contribution to journalArticle

44 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)316-323
Number of pages8
JournalAmerican Journal of Medicine
Volume121
Issue number4
DOIs
StatePublished - Apr 2008

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Reperfusion
Therapeutics
Pharmaceutical Preparations
ST Elevation Myocardial Infarction
Needles
Registries
Cohort Studies
Myocardial Infarction

Keywords

  • Angioplasty
  • Fibrinolysis
  • Myocardial infarction
  • Quality
  • Reperfusion

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Ting, H. H., Bradley, E. H., Wang, Y., Nallamothu, B. K., Gersh, B. J., Roger, V. L., ... Krumholz, H. M. (2008). Delay in Presentation and Reperfusion Therapy in ST-Elevation Myocardial Infarction. American Journal of Medicine, 121(4), 316-323. https://doi.org/10.1016/j.amjmed.2007.11.017

Delay in Presentation and Reperfusion Therapy in ST-Elevation Myocardial Infarction. / Ting, Henry H.; Bradley, Elizabeth H.; Wang, Yongfei; Nallamothu, Brahmajee K.; Gersh, Bernard J.; Roger, Veronique Lee; Lichtman, Judith H.; Curtis, Jeptha P.; Krumholz, Harlan M.

In: American Journal of Medicine, Vol. 121, No. 4, 04.2008, p. 316-323.

Research output: Contribution to journalArticle

Ting, HH, Bradley, EH, Wang, Y, Nallamothu, BK, Gersh, BJ, Roger, VL, Lichtman, JH, Curtis, JP & Krumholz, HM 2008, 'Delay in Presentation and Reperfusion Therapy in ST-Elevation Myocardial Infarction', American Journal of Medicine, vol. 121, no. 4, pp. 316-323. https://doi.org/10.1016/j.amjmed.2007.11.017
Ting, Henry H. ; Bradley, Elizabeth H. ; Wang, Yongfei ; Nallamothu, Brahmajee K. ; Gersh, Bernard J. ; Roger, Veronique Lee ; Lichtman, Judith H. ; Curtis, Jeptha P. ; Krumholz, Harlan M. / Delay in Presentation and Reperfusion Therapy in ST-Elevation Myocardial Infarction. In: American Journal of Medicine. 2008 ; Vol. 121, No. 4. pp. 316-323.
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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.",
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AU - Bradley, Elizabeth H.

AU - Wang, Yongfei

AU - Nallamothu, Brahmajee K.

AU - Gersh, Bernard J.

AU - Roger, Veronique Lee

AU - Lichtman, Judith H.

AU - Curtis, Jeptha P.

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AB - 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.

KW - Angioplasty

KW - Fibrinolysis

KW - Myocardial infarction

KW - Quality

KW - Reperfusion

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