TY - JOUR
T1 - When is door-to-balloon time critical? Analysis from the HORIZONS-AMI (Harmonizing outcomes with revascularization and stents in acute myocardial infarction) and CADILLAC (Controlled abciximab and device investigation to lower late angioplasty complications) trials
AU - Brodie, Bruce R.
AU - Gersh, Bernard J.
AU - Stuckey, Thomas
AU - Witzenbichler, Bernhard
AU - Guagliumi, Giulio
AU - Peruga, Jan Z.
AU - Dudek, Dariusz
AU - Grines, Cindy L.
AU - Cox, David
AU - Parise, Helen
AU - Prasad, Abhiram
AU - Lansky, Alexandra J.
AU - Mehran, Roxana
AU - Stone, Gregg W.
N1 - Funding Information:
This study was supported by the Cardiovascular Research Foundation , with grant support from Boston Scientific and the Medicines Company , Guidant Corporation , and Lilly Research Laboratories . Dr. Gersh has served on the advisory board of Abbott Vascular and Boston Scientific. Dr. Stuckey has served as a consultant to and been on the Speakers' Bureau and advisory board of Boston Scientific. Dr. Witzenbichler is a consultant for and on the Speakers' Bureau of The Medicines Company, Boston Scientific, and Abbott Vascular. Dr. Guagliumi has served as a consultant to Boston Scientific and Volcano and received research grants from Boston Scientific , Medtronic , LightLab , and Abbott Vascular . Dr. Cox has served on the advisory board of Abbott Vascular and Boston Scientific and the Speakers' Bureau of Abbott Vascular, Boston Scientific, and The Medicines Company. Dr. Lansky has received unrestricted research support from Abbott Vascular and The Medicines Company . Dr. Mehran has received grant support from Bristol-Myers Squibb/Sanofi and Bracco , and has served as a consultant to and received honoraria from Abiomed, Abbott, Accumetrics, Bracco, Cordis, Eli Lilly/Daichii Sankyo, Gileau, Guerbet, Regado, and Therox. Dr. Stone has served on the advisory board of Abbott Vascular and Boston Scientific.
PY - 2010/7/27
Y1 - 2010/7/27
N2 - Objectives: Our objective was to evaluate the impact of door-to-balloon time (DBT) on mortality depending on clinical risk and time to presentation. Background: DBT affects the mortality rate in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, but the impact may vary across subgroups. Methods: The CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) and HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trials evaluated stent and antithrombotic therapy in patients undergoing primary percutaneous coronary intervention. We studied the impact of DBT on mortality in 4,548 patients based on time to presentation and clinical risk. Results: The 1-year mortality rate was lower in patients with short versus long DBT (≤90 min vs. >90 min, 3.1% vs. 4.3%, p = 0.045). Short DBTs were associated with a lower mortality rate in patients with early presentation (≤90 min: 1.9% vs. 3.8%, p = 0.029) but not those with later presentation (>90 min: 4.0% vs. 4.6%, p = 0.47). Short DBTs showed similar trends for a lower mortality rate in high-risk (5.7% vs. 7.4%, p = 0.12) and low-risk (1.1% vs. 1.6%, p = 0.25) patients. Short DBTs had similar relative risk reductions in patients with early presentation in high-risk (3.7% vs. 7.0%, p = 0.08) and low-risk (0.8% vs. 1.5%, p = 0.32) patients, although the absolute benefit was greatest in high-risk patients. Conclusions: Short DBTs (≤90 min) are associated with a lower mortality rate in patients with early presentation but have less impact on the mortality rate in patients presenting later. The absolute mortality rate reduction with short DBT is greatest in high-risk patients presenting early. These data may be helpful in designing triage strategies for reperfusion therapy in patients presenting to nonpercutaneous coronary intervention hospitals.
AB - Objectives: Our objective was to evaluate the impact of door-to-balloon time (DBT) on mortality depending on clinical risk and time to presentation. Background: DBT affects the mortality rate in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, but the impact may vary across subgroups. Methods: The CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) and HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trials evaluated stent and antithrombotic therapy in patients undergoing primary percutaneous coronary intervention. We studied the impact of DBT on mortality in 4,548 patients based on time to presentation and clinical risk. Results: The 1-year mortality rate was lower in patients with short versus long DBT (≤90 min vs. >90 min, 3.1% vs. 4.3%, p = 0.045). Short DBTs were associated with a lower mortality rate in patients with early presentation (≤90 min: 1.9% vs. 3.8%, p = 0.029) but not those with later presentation (>90 min: 4.0% vs. 4.6%, p = 0.47). Short DBTs showed similar trends for a lower mortality rate in high-risk (5.7% vs. 7.4%, p = 0.12) and low-risk (1.1% vs. 1.6%, p = 0.25) patients. Short DBTs had similar relative risk reductions in patients with early presentation in high-risk (3.7% vs. 7.0%, p = 0.08) and low-risk (0.8% vs. 1.5%, p = 0.32) patients, although the absolute benefit was greatest in high-risk patients. Conclusions: Short DBTs (≤90 min) are associated with a lower mortality rate in patients with early presentation but have less impact on the mortality rate in patients presenting later. The absolute mortality rate reduction with short DBT is greatest in high-risk patients presenting early. These data may be helpful in designing triage strategies for reperfusion therapy in patients presenting to nonpercutaneous coronary intervention hospitals.
KW - door-to-balloon time
KW - myocardial infarction
KW - primary percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=77955283384&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2010.04.020
DO - 10.1016/j.jacc.2010.04.020
M3 - Article
C2 - 20650362
AN - SCOPUS:77955283384
SN - 0735-1097
VL - 56
SP - 407
EP - 413
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 5
ER -