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

被引：92

作者：

Brodie, Bruce R. ^{[1
]}

Gersh, Bernard J. ^{[2
]}

Stuckey, Thomas ^{[1
]}

Witzenbichler, Bernhard ^{[3
]}

Guagliumi, Giulio ^{[4
]}

Peruga, Jan Z. ^{[5
]}

Dudek, Dariusz ^{[6
]}

Grines, Cindy L. ^{[7
]}

Cox, David ^{[8
]}

Parise, Helen ^{[9
,10
]}

Prasad, Abhiram ^{[2
]}

Lansky, Alexandra J. ^{[9
,10
]}

Mehran, Roxana ^{[9
,10
]}

Stone, Gregg W. ^{[9
,10
]}

机构：

[1] LeBauer Cardiovasc Res Fdn, Greensboro, NC USA

[2] Mayo Clin, Rochester, MN USA

[3] Charite Campus Benjamin Franklin, Berlin, Germany

[4] Osped Riuniti Bergamo, I-24100 Bergamo, Italy

[5] Silesian Ctr Heart Dis, Lodz, Poland

[6] Jagiellonian Univ, Krakow, Poland

[7] William Beaumont Hosp, Royal Oak, MI 48072 USA

[8] Lehigh Valley Hosp, Allentown, PA USA

[9] Columbia Univ, Med Ctr, New York, NY USA

[10] Cardiovasc Res Fdn, New York, NY USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2010年 / 56卷 / 05期

关键词：

door-to-balloon time; myocardial infarction; primary percutaneous coronary intervention; PERCUTANEOUS CORONARY INTERVENTION; MORTALITY; PCI; ONSET;

D O I：

10.1016/j.jacc.2010.04.020

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 non-percutaneous coronary intervention hospitals. (J Am Coll Cardiol 2010;56:407-13) (c) 2010 by the American College of Cardiology Foundation

引用

页码：407 / 413

页数：7

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