Impact of treatment delays on outcomes of primary percutaneous coronary intervention for acute myocardial infarction: Analysis from the CADILLAC trial
2006; Elsevier BV; Volume: 151; Issue: 6 Linguagem: Inglês
10.1016/j.ahj.2005.07.016
ISSN1097-6744
AutoresBruce R. Brodie, Gregg W. Stone, David A. Cox, Thomas Stuckey, Mark Turco, James E. Tcheng, Peter B. Berger, Roxana Mehran, Michael G. McLaughlin, Costantino Costantini, Alexandra J. Lansky, Cindy L. Grines,
Tópico(s)Cardiac Imaging and Diagnostics
ResumoThe impact of treatment delays on outcomes after primary percutaneous coronary intervention for acute myocardial infarction is controversial. The CADILLAC trial randomized 2082 patients with acute myocardial infarction to stenting versus percutaneous transluminal coronary angioplasty, each with or without abciximab. Earlier reperfusion ( 6 hours) was associated with lower 1-year mortality (2.6% vs 4.3% vs 4.8%, P = .046 for <3 vs ≥3 hours), more frequent grade 2 to 3 myocardial blush (55% vs 53% vs 44%, P = .003), more frequent complete ST-segment resolution (64% vs 68% vs 47%, P = .006), and greater improvement in left ventricular function. Early reperfusion (<3 vs 3-6 vs ≥3 hours) was associated with lower mortality in high-risk patients (3.8% vs 6.9% vs 7.0%, P = .051 for 2 hours, heart rate 0.88, P = .33). Early reperfusion results in superior clinical outcomes, enhanced microvascular reperfusion, and better recovery of left ventricular function. Incremental treatment delays impact mortality more in high-risk versus low-risk patients and more in patients presenting early versus late after the onset of symptoms. These data emphasize the importance of minimizing treatment delays and have implications regarding patient triage for primary percutaneous coronary intervention.
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