Clinical InvestigationAcute Ischemic Heart DiseaseImpact of treatment delays on outcomes of primary percutaneous coronary intervention for acute myocardial infarction: Analysis from the CADILLAC trial
Section snippets
Study population and study protocol
The CADILLAC trial enrolled patients with no shock but with AMI of <12 hours' duration who had either ST-segment elevation or left bundle-branch block, or angiographically severe coronary stenosis associated with a regional wall motion (RWM) abnormality. Patients (n = 2082) were randomized to 1 of 4 reperfusion strategies: balloon angioplasty alone, angioplasty plus abciximab, stent alone, or stent plus abciximab.8 Time to reperfusion data were available in 2002 patients and door-to-balloon
Treatment times
Median treatment times were as follows: time to presentation, 1.78 (1.00, 3.43) hours; door-to-balloon time, 2.00 (1.48, 2.72) hours; and time to reperfusion, 3.97 (2.88, 6.10) hours. Only 21% of patients presented to the hospital within 1 hour of symptom onset, only 26% of patients had door-to-balloon times <90 minutes, and only 27% of patients were reperfused within 3 hours of symptom onset (Figure 1).
Baseline variables and treatment times
Patients with longer times to reperfusion were more likely to be older, female, and treated
Discussion
The major findings of this study are (1) early reperfusion with primary PCI for AMI is associated with superior clinical outcomes, enhanced microvascular reperfusion, and better recovery of left ventricular function; (2) delays in reperfusion impact mortality in high-risk patients but not low-risk patients; (3) incremental delays in reperfusion appear to have a greater impact on mortality in patients presenting early versus late after the onset of symptoms; and (4) Only a minority of patients
References (27)
- et al.
Impact of time to treatment with tissue plasminogen activator on morbidity and mortality following acute myocardial infarction (Second National Registry of Myocardial Infarction)
Am J Cardiol
(1998) - et al.
Importance of time to reperfusion for 30 day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction
J Am Coll Cardiol
(1998) - et al.
Importance of time to reperfusion on outcomes with primary coronary angioplasty for acute myocardial infarction: results from the stent primary angioplasty in myocardial infarction trial
Am J Cardiol
(2001) - et al.
Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty
Am J Cardiol
(2002) - et al.
Symptom-onset–to–balloon time and mortality in patients with acute myocardial infarction treated by primary angioplasty
J Am Coll Cardiol
(2003) - et al.
Frequency, correlates and clinical implications of myocardial perfusion after primary angioplasty and stenting, with and without glycoprotein IIb/IIIa inhibition, in acute myocardial infarction
J Am Coll Cardiol
(2004) - et al.
The use of biplane angiocardiography for the measurement of left ventricular volume in man
Am Heart J
(1960) - et al.
Prognostic utility of comparative methods for assessment of ST-segment resolution after primary angioplasty for acute myocardial infarction: the CADILLAC trial
J Am Coll Cardiol
(2004) - et al.
Importance of time to reperfusion in patients with acute myocardial infarction with and without cardiogenic shock treated with primary percutaneous coronary intervention
Am Heart J
(2003) - et al.
Influence of time to treatment on early infarct-related artery patency after different thrombolytic regimens
Am Heart J
(1999)
Cardiac rupture, mortality and the timing of thrombolytic therapy: a meta-analysis
J Am Coll Cardiol
Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction
J Am Coll Cardiol
Time to therapy and salvage in myocardial infarction
J Am Coll Cardiol
Cited by (113)
The prognostic significance of Q waves and T wave inversions in the ECG of patients with STEMI: A substudy of the TOTAL trial
2023, Journal of ElectrocardiologyPercutaneous Myocardial Revascularization in Late-Presenting Patients With STEMI
2021, Journal of the American College of CardiologyThe prognostic significance of grade of ischemia in the ECG in patients with ST-elevation myocardial infarction: A substudy of the randomized trial of primary PCI with or without routine manual thrombectomy (TOTAL trial)
2021, Journal of ElectrocardiologyCitation Excerpt :According to the prevailing guidelines, patients with STEMI should undergo reperfusion therapy as expeditiously as possible (28). Study results are inconclusive regarding the prognostic significance of time from symptom onset to reperfusion therapy: the results from some studies indicate that STEMI patients with a longer time delay have worse outcome, while other studies found no clear evidence for an independent role of time delays (29–34). Previous studies showed that compared to patients with G2I, those with G3I have higher in-hospital and 30-day mortality and less myocardial salvage when presenting late - two to three hours from symptom onset - but not when presenting earlier (2,20,35).
Impact of pre-angioplasty antithrombotic therapy administration on coronary reperfusion in ST-segment elevation myocardial infarction: Does time matter?
2021, International Journal of Cardiology