Therapy-Dependent Influence of Time-to-Treatment Interval on Myocardial Salvage in Patients With Acute Myocardial Infarction Treated With Coronary Artery Stenting or Thrombolysis

Abstract

Background-The relationship between myocardial salvage and time-to-treatment interval in patients with acute myocardial infarction (AMI) treated with coronary artery stenting or thrombolysis has not been studied. Methods and Results-This study analyzed 264 patients with AMI randomized to coronary stenting (133 patients) or thrombolysis (131 patients) in the setting of 2 randomized trials. Patients were divided into the following 3 groups defined by tertiles of the time-to-treatment interval: lower tertile (Ͻ165 minutes), middle tertile (165 to 280 minutes), and upper tertile (Ͼ280 minutes). Paired scintigraphic examinations were performed to obtain salvage index, which was the primary end point of the study. In the group with thrombolysis, the salvage index (median

Influence of Time to Treatment Interval on Myocardial Salvage in Patients With Acute Myocardial Infarction Treated With Coronary Artery Stenting or Thrombolysis

“…In conclusion, the results of our study, 1 and of the additional analyses presented here, support the position of Dr Elsman and colleagues that the efficacy of thrombolysis in patients with acute myocardial infarction is largely confined to a short time interval after symptom onset. In addition, our results indicate that coronary stenting is superior to thrombolysis even in this short interval.…”

“…1 The objective of our study was the assessment of the time dependence of efficacy of thrombolysis or coronary stenting in patients with acute myocardial infarction. Larger and specifically designed studies are required to define cutoff time intervals that may guide selection of optimal reperfusion strategy.…”

Selecting the Best Reperfusion Strategy in ST-Elevation Myocardial Infarction

“…12 Primary PCI with adjunctive glycoprotein IIb/IIIa inhibitor may improve myocardial salvage compared with pharmacological reperfusion. 11,12 In 1989, we expanded the then standard paradigm (early reperfusion 3 smaller infarct 3 improved survival) to include other potential benefits of an open infarct-related artery, which include perfusion of hibernating myocardium, improved healing, the prevention of infarct expansion, and of ventricular remodeling. 13,14 Because PCI is very effective (Ͼ90%) at restoring epicardial flow and improving microvascular flow even hours after the onset of coronary occlusion, it is especially well suited to reap these purported benefits of arterial opening in patients who present relatively late.…”

“…11,19 In addition, patients who present later tend to be older, have more comorbidities, and are at increased risk for intracranial bleeding. Patients over the age of 75 years experience a 3-fold increase in death, reinfarction, or stroke after fibrinolysis compared with primary PCI.…”

Treatment Delayed Is Treatment Denied

“…In fact, within the early hours of STEMI, recent studies suggest that there is no superiority of primary PCI over thrombolytic therapy in terms of mortality rate. 17,18 Forthcoming American Heart Association/American College of Cardiology guidelines for treatment of STEMI will support this concept that circumstances do exist in which thrombolytic therapy is preferred as the initial reperfusion strategy. Furthermore, some have advocated the routine administration of full-or partial-dose thrombolytic therapy before performing primary angioplasty, particularly if a delay may be anticipated.…”