Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events

Objective: Treatment delays may result in different clinical outcomes in patients with ST- segment elevation myocardial infarction ( STEMI) who receive fibrinolytic therapy vs primary percutaneous coronary intervention ( PCI). The aim of this analysis was to examine how treatment delays relate to 6- month mortality in reperfusion- treated patients enrolled in the Global Registry of Acute Coronary Events ( GRACE). Design: Prospective, observational cohort study. Setting: 106 hospitals in 14 countries. Patients: 3959 patients who presented with STEMI within 6 h of symptom onset and received reperfusion with either a fibrin- specific fibrinolytic drug or primary PCI. Main outcome measures: 6- month mortality. Methods: Multivariable logistic regression was used to assess the relationship between outcomes and treatment delay separately in each cohort, with time modelled with a quadratic term after adjusting for covariates from the GRACE risk score. Results: A total of 1786 ( 45.1%) patients received fibrinolytic therapy, and 2173 ( 54.9%) underwent primary PCI. After multivariable adjustment, longer treatment delays were associated with a higher 6- month mortality in both fibrinolytic therapy and primary PCI patients (p<0.001 for both cohorts). For patients who received fibrinolytic therapy, 6- month mortality increased by 0.30% per 10- min delay in door- to- needle time between 30 and 60 min compared with 0.18% per 10- min delay in door- to- balloon time between 90 and 150 min for patients undergoing primary PCI. Conclusions: Treatment delays in reperfusion therapy are associated with higher 6- month mortality, but this relationship may be even more critical in patients receiving fibrinolytic therapy.