Impact of Time to Treatment on Mortality After Prehospital Fibrinolysis or Primary Angioplasty
- 9 December 2003
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 108 (23), 2851-2856
- https://doi.org/10.1161/01.cir.0000103122.10021.f2
Abstract
Background— CAPTIM was a randomized trial comparing prehospital thrombolysis with transfer to an interventional facility (and, if needed, percutaneous intervention) with primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI). Because the benefit of thrombolysis is maximal during the first 2 hours after symptom onset, and because prehospital thrombolysis can be implemented earlier than PCI, this analysis studied the relationship between the effect of assigned treatment and the time elapsed from symptom onset. Methods and Results— Randomization within 2 hours (n=460) or ≥2 hours (n=374) after symptom onset had no impact on the effect of treatment on the 30-day combined primary end point of death, nonfatal reinfarction, and disabling stroke. However, patients randomized P =0.058), whereas mortality was similar in patients randomized ≥2 hours (5.9% versus 3.7%, P =0.47). There was a significant interaction between treatment effect and delay with respect to 30-day mortality (hazard ratio 4.19, 95% CI 1.033 to 17.004, P =0.045). Among patients randomized in the first 2 hours, cardiogenic shock was less frequent with lytic therapy than with primary PCI (1.3% versus 5.3%, P =0.032), whereas rates were similar in patients randomized later. Conclusions— Time from symptom onset should be considered when one selects reperfusion therapy in STEMI. Prehospital thrombolysis may be preferable to primary PCI for patients treated within the first 2 hours after symptom onset.Keywords
This publication has 27 references indexed in Scilit:
- Fibrinolytic TherapyCirculation, 2003
- Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trialsThe Lancet, 2003
- Clinical characteristics and outcome of patients with early (4h) presentation treated by primary coronary angioplasty or thrombolytic therapy for acute myocardial infarctionEuropean Heart Journal, 2002
- Multicentre randomized trial comparing transport to primary angioplasty vs immediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory. The PRAGUE StudyEuropean Heart Journal, 2000
- Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic ShockNew England Journal of Medicine, 1999
- Frequency and clinical outcome of cardiogenic shock during acute myocardial infarction among patients receiving reteplase or alteplase. Results from GUSTO-IIIEuropean Heart Journal, 1999
- Efficacy of Streptokinase, but Not Tissue-Type Plasminogen Activator, in Achieving 90-Minute Patency After Thrombolysis for Acute Myocardial Infarction Decreases With Time to TreatmentJournal of the American College of Cardiology, 1998
- Thrombolysis in acute myocardial infarction complicated by cardiogenic shockJournal of Thrombosis and Thrombolysis, 1995
- Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patientsThe Lancet, 1994
- Endothelium-Dependent Regulation of Resistance ArteriesJournal of Cardiovascular Pharmacology, 1992