This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Liem, A. L. Articles by Zijlstra, F. Search for Related Content PubMed PubMed Citation Articles by Liem, A. L. Articles by Zijlstra, F.

CLINICAL STUDIES

Influence of treatment delay on infarct size and clinical outcome in patients with acute myocardial infarction treated with primary angioplasty

^a Department of Cardiology, Hospital de Weezenlanden, Zwolle, The Netherlands

Manuscript received December 29, 1997; revised manuscript received April 22, 1998, accepted May 11, 1998.

Address for correspondence: Dr. Felix Zijlstra, Department of Cardiology, Hospital de Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands

Objectives. The purpose of this analysis was to determine the influence of an additional treatment delay inherent in transfer to an angioplasty center for primary angioplasty of patients with acute myocardial infarction who are first admitted to hospitals without angioplasty facilities.

Background. Several randomized trials have demonstrated the benefits of primary angioplasty in acute myocardial infarction. In recent years, increasing numbers of patients with myocardial infarction, initially admitted to hospitals without angioplasty facilities are transported to our hospital for primary angioplasty. However, the additional delay due to the transport may have a deleterious effect on infarct size and clinical outcome.

Methods. In a three-year period (December 1993 to November 1996), 207 consecutive patients who were transferred for primary angioplasty were analyzed in a matched comparison with nontransferred patients. Matching criteria were age, sex, infarct location, presentation delay and Killip class.

Results. Patients who were transferred had an additional median delay of 43 min. This resulted in a more extensive enzymatic infarct size and a lower ejection fraction measured at 6 months. The rate of angioplasty success defined as TIMI grade 3 flow, and the 6-month mortality rate (7%) were comparable in both groups.

Conclusions. The additional delay had a deleterious effect on myocardial salvage, reflected by a larger infarct size and a lower left ventricular function. However, the patency rate and 6-month clinical outcome were not affected by this delay.

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   IRV = infarct-related vessel   IU = international units   LDH = lactate dehydrogenase   LVEF = left ventricular ejection fraction   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   TIMI = thrombolysis in myocardial infarction

This article has been cited by other articles:

				S. S Rathore, J. P Curtis, J. Chen, Y. Wang, B. K Nallamothu, A. J Epstein, H. M Krumholz, and for the National Cardiovascular Data Registry Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study BMJ, May 19, 2009; 338(may19_1): b1807 - b1807. [Abstract] [Full Text] [PDF]

				S. G. Ellis, M. Tendera, M. A. de Belder, A. J. van Boven, P. Widimsky, L. Janssens, H.R. Andersen, A. Betriu, S. Savonitto, J. Adamus, et al. Facilitated PCI in Patients with ST-Elevation Myocardial Infarction N. Engl. J. Med., May 22, 2008; 358(21): 2205 - 2217. [Abstract] [Full Text] [PDF]

				H. Sakamoto, L. M. Parish, H. Hamamoto, L. P. Ryan, T. J. Eperjesi, T. J. Plappert, B. M. Jackson, M. G. St John-Sutton, J. H. Gorman III, and R. C. Gorman Effect of Reperfusion on Left Ventricular Regional Remodeling Strains After Myocardial Infarction Ann. Thorac. Surg., November 1, 2007; 84(5): 1528 - 1536. [Abstract] [Full Text] [PDF]

				S. Carstensen, G. C.I. Nelson, P. S. Hansen, L. Macken, S. Irons, M. Flynn, P. Kovoor, S. Y. Soo Hoo, M. R. Ward, and H. H. Rasmussen Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome Eur. Heart J., October 1, 2007; 28(19): 2313 - 2319. [Abstract] [Full Text] [PDF]

				D. Dudek, T. Rakowski, A. Dziewierz, and W. Mielecki Time delay in primary angioplasty: how relevant is it? Heart, October 1, 2007; 93(10): 1164 - 1166. [Full Text] [PDF]

				T. P. Wharton Jr, E. C. Keeley, C. L. Grines, T. P. Wharton Jr, E. C. Keeley, and C. L. Grines The Case for Community Hospital Angioplasty Circulation, November 29, 2005; 112(22): 3509 - 3534. [Full Text] [PDF]

				R Zahn, A Vogt, U Zeymer, A K Gitt, K Seidl, M Gottwik, M A Weber, W Niederer, B Modl, H-J Engel, et al. In-hospital time to treatment of patients with acute ST elevation myocardial infarction treated with primary angioplasty: determinants and outcome. Results from the registry of percutaneous coronary interventions in acute myocardial infarction of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausarzte Heart, August 1, 2005; 91(8): 1041 - 1046. [Abstract] [Full Text] [PDF]

				H. C. Herrmann Transfer for Primary Angioplasty: The Importance of Time Circulation, February 15, 2005; 111(6): 718 - 720. [Full Text] [PDF]

				P. Widimsky, T. Budesinsky, D. Vorac, L. Groch, M. Zelizko, M. Aschermann, M. Branny, J. St'asek, P. Formanek, and on behalf of the 'PRAGUE' Study Group Investigator Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction: Final results of the randomized national multicentre trial--PRAGUE-2 Eur. Heart J., January 1, 2003; 24(1): 94 - 104. [Abstract] [Full Text] [PDF]

				R. H. Mehta, D. A. Criger, C. B. Granger, K. K. Pieper, R. M. Califf, E. J. Topol, and E. R. Bates Patient outcomes after fibrinolytic therapy for acute myocardial infarction at hospitals with and without coronary revascularization capability J. Am. Coll. Cardiol., September 18, 2002; 40(6): 1034 - 1040. [Abstract] [Full Text] [PDF]

				M. Singh, H. H. Ting, P. B. Berger, K. N. Garratt, D. R. Holmes Jr, and B. J. Gersh Rationale for on-site cardiac surgery for primary angioplasty: a time for reappraisal J. Am. Coll. Cardiol., June 19, 2002; 39(12): 1881 - 1889. [Abstract] [Full Text] [PDF]

				E.M. Antman, H.A. Cooper, C.M. Gibson, J.A. de Lemos, C.H. McCabe, R.P. Giugliano, P. Coussement, S. Murphy, J. Scherer, K. Anderson, et al. Determinants of improvement in epicardial flow and myocardial perfusion for ST elevation myocardial infarction. Insights from TIMI 14 and InTIME-II Eur. Heart J., June 2, 2002; 23(12): 928 - 933. [Abstract] [Full Text] [PDF]

				F Zijlstra, A Patel, M Jones, C.L Grines, S Ellis, E Garcia, L Grinfeld, R.J Gibbons, E.E Ribeiro, F Ribichini, et al. Clinical characteristics and outcome of patients with early (<2h), intermediate (2-4h) and late (>4h) presentation treated by primary coronary angioplasty or thrombolytic therapy for acute myocardial infarction Eur. Heart J., April 1, 2002; 23(7): 550 - 557. [Abstract] [Full Text] [PDF]

				I. Sheiban, G. Fragasso, G. M. C. Rosano, A. Dharmadhikari, V. Tzifos, P. Pagnotta, S. L. Chierchia, and G. Trevi Time course and determinants of left ventricular function recovery after primary angioplasty in patients with acute myocardial infarction J. Am. Coll. Cardiol., August 1, 2001; 38(2): 464 - 471. [Abstract] [Full Text] [PDF]

				A. B. Greenbaum, R. A. Harrington, M. P. Hudson, C. M. MacAulay, R. G. Wilcox, M. L. Simoons, L. G. Berdan, A. Guerci, D. V. Cokkinos, M. M. Kitt, et al. Therapeutic value of eptifibatide at community hospitals transferring patients to tertiary referral centers early after admission for acute coronary syndromes J. Am. Coll. Cardiol., February 1, 2001; 37(2): 492 - 498. [Abstract] [Full Text] [PDF]

				F. Zijlstra Long-term benefit of primary angioplasty compared to thrombolytic therapy for acute myocardial infarction Eur. Heart J., September 2, 2000; 21(18): 1487 - 1489. [PDF]

				R. Zahn, R. Schiele, K. Seidl, T. Kapp, H. G. Glunz, E. Jagodzinski, T. Voigtlander, M. Gottwik, G. Berg, H. Thomas, et al. Acute myocardial infarction occurring in versus out of the hospital: patient characteristics and clinical outcome J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1820 - 1826. [Abstract] [Full Text] [PDF]

				P. Widimsky, L. Groch, M. Zelizko, M. Aschermann, F. Bednar, and H. Suryapranata 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 Study Eur. Heart J., May 2, 2000; 21(10): 823 - 831. [Abstract] [PDF]

				E. Boersma, M. Akkerhuis, M. L. Simoons, F. Zijlstra, M.-J. de Boer, D. P. Faxon, and J. W. Heger Primary Angioplasty versus Thrombolysis for Acute Myocardial Infarction N. Engl. J. Med., March 23, 2000; 342(12): 890 - 892. [Full Text]

				A. M. Ross, K. S. Coyne, J. S. Reiner, S. W. Greenhouse, C. Fink, A. Frey, E. Moreyra, M. Traboulsi, N. Racine, A. L. Riba, et al. A randomized trial comparing primary angioplasty with a strategy of short-acting thrombolysis and immediate planned rescue angioplasty in acute myocardial infarction: the PACT trial J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1954 - 1962. [Abstract] [Full Text] [PDF]