Time to reperfusion: The critical modulator in thrombolysis and primary angioplasty

Abstract

Rapid achievement of reperfusion with thrombolytic therapy or primary angioplasty has made a dramatic impact an improving the survival of patients with acute myocardial infarction (MI). Restoring infarct-related artery patency early after the onset of MI minimizes infarct size, reduces the degree of left ventricular dysfunction, and improves survival. Several recent studies have confirmed the benefit of reducing time to treatment with thrombolysis (between the onset of pain to initiation of thrombolysis), and that of more rapid drug reperfusion time with more aggressive thrombolytic regimens (between initiation of thrombolytic therapy and actual achievement of reperfusion). Furthermore, these effects are additive, confirming the benefit of rapid reperfusion. For primary angioplasty, the same relationship has been observed-more rapid treatment appears to be associated with improved outcome. The "door-to-balloon" time is a major determinant of overall time to reperfusion, and as such is a crucial component of the overall strategy. Integrating the experience in trials of thrombolytic therapy and primary angioplasty, a clear relationship exists between higher rates of early reperfusion and lower mortality. Thus, time to reperfusion appears to be the critical modulator in both thrombolysis and primary angioplasty.

Acute Coronary Syndromes: Diagnosis and Management, Part I

“…40 In contrast, in STEMI, the infarct-related artery is usually totally occluded, and immediate pharmacological or catheter-based reperfusion is the initial approach, with the goal of obtaining normal coronary blood flow. 41 Other therapies, such as anti-ischemic and lipid-lowering therapies, are used in all cases to stabilize plaques over the long term.…”

Relationship of Symptom-Onset-to-Balloon Time and Door-to-Balloon Time With Mortality in Patients Undergoing Angioplasty for Acute Myocardial Infarction

“…In contrast, if the door-to-balloon time is 2 hours or longer, as observed over all 4 years in this large multicenter study, and in other registries of current practice, 11,12,39,40 patency would be achieved at the 90-minute point in only 30% to 40% of patients. 39,41 Thus, door-toballoon time would have a profound influence on early patency of the infarctrelated artery. It is not surprising that there is no difference in mortality comparing thrombolytic therapy with relatively delayed primary angioplasty.…”

Can mechanical thrombectomy replace angioplasty for the treatment of patients with ST-segment elevation myocardial infarction (STEMI)? Report of a case

“…ST-segment elevation myocardial infarction (STEMI) results from occlusive thrombus formation at the site of plaque rupture or erosion (DeWood et al, 1980;Falk, 1983). Rapid restoration of TIMI grade 3 flow is closely associated with improved survival (Cannon, 2001;Cannon and Braunwald, 1996). The current management of STEMI consists of primary angioplasty, including thrombus aspiration and stenting (Yang et al, 2005;Svilaas et al, 2008).…”