Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction - Every minute of delay counts
Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction - Every minute of delay counts
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DOI：
10.1161/01.cir.0000121424.76486.20
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发表时间：
2004-03-16
期刊：
影响因子：
37.8
通讯作者：
Antman, EM
中科院分区：
文献类型：
--
作者：
De Luca, G;Suryapranata, H;Antman, EM
背景——尽管在接受溶栓治疗的急性st段抬高型心肌梗死（STEMI）患者中，死亡率与治疗时间延迟之间的关系已经得到证实，但时间延迟对初级血管成形术患者预后的影响尚不清楚。本报告的目的是将治疗时间与死亡率之间的关系作为一个连续函数加以讨论，并估计每延迟30分钟的死亡率风险。方法和结果-研究人群包括1791例经原发性血管成形术治疗的STEMI患者。缺血时间与1年死亡率之间的关系被评估为连续函数，并用二次回归模型绘制。使用Cox比例风险回归模型计算相对风险（每30分钟延迟），并根据与缺血时间相关的基线特征进行调整。与治疗时间相关的变量为：年龄0 ~ 70岁（P < 0.0001）、女性（P = 0.004）、是否患有糖尿病（P = 0.002）、是否有过血运重建术（P = 0.035）。再灌注成功的患者缺血时间明显缩短（P = 0.006）。随访1年，103例患者（5.8%）死亡。在调整了年龄、性别、糖尿病和既往血运重建术后，每延迟30分钟与1年死亡率的相对风险相关1.075 （95% CI 1.008 ~ 1.15; P = 0.041）。结论：这些结果表明，STEMI的初级血管成形术每延迟一分钟都会影响1年死亡率，即使在基线特征调整后也是如此。因此，无论是溶栓治疗还是初次血管成形术，都应尽量缩短总缺血时间。
Background - Although the relationship between mortality and time delay to treatment has been demonstrated in patients with acute ST-segment elevation myocardial infarction (STEMI) treated by thrombolysis, the impact of time delay on prognosis in patients undergoing primary angioplasty has yet to be clarified. The aim of this report was to address the relationship between time to treatment and mortality as a continuous function and to estimate the risk of mortality for each 30-minute delay.Methods and Results - The study population consisted of 1791 patients with STEMI treated by primary angioplasty. The relationship between ischemic time and 1-year mortality was assessed as a continuous function and plotted with a quadratic regression model. The Cox proportional hazards regression model was used to calculate relative risks ( for each 30 minutes of delay), adjusted for baseline characteristics related to ischemic time. Variables related to time to treatment were age >70 years ( P < 0.0001), female gender ( P = 0.004), presence of diabetes mellitus ( P = 0.002), and previous revascularization ( P = 0.035). Patients with successful reperfusion had a significantly shorter ischemic time ( P = 0.006). A total of 103 patients (5.8%) had died at 1-year follow-up. After adjustment for age, gender, diabetes, and previous revascularization, each 30 minutes of delay was associated with a relative risk for 1-year mortality of 1.075 (95% CI 1.008 to 1.15; P = 0.041).Conclusions - These results suggest that every minute of delay in primary angioplasty for STEMI affects 1-year mortality, even after adjustment for baseline characteristics. Therefore, all efforts should be made to shorten the total ischemic time, not only for thrombolytic therapy but also for primary angioplasty.