Relationship of Symptom-Onset-to-Balloon Time and Door-to-Balloon Time With Mortality in Patients Undergoing Angioplasty for Acute Myocardial Infarction
CONTEXT Rapid time to treatment with thrombolytic therapy is associated with lower mortality in patients with acute myocardial infarction (MI). However, data on time to primary angioplasty and its relationship to mortality are inconclusive. OBJECTIVE To test the hypothesis that more rapid time to re...
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2000-06, Vol.283 (22), p.2941-2947 |
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| creator | Cannon, Christopher P Gibson, C. Michael Lambrew, Costas T Shoultz, David A Levy, Drew French, William J Gore, Joel M Weaver, W. Douglas Rogers, William J Tiefenbrunn, Alan J |
| description | CONTEXT Rapid time to treatment with thrombolytic therapy is associated with
lower mortality in patients with acute myocardial infarction (MI). However,
data on time to primary angioplasty and its relationship to mortality are
inconclusive. OBJECTIVE To test the hypothesis that more rapid time to reperfusion results in
lower mortality in the strategy of primary angioplasty. DESIGN Prospective observational study of data collected from the Second National
Registry of Myocardial Infarction between June 1994 and March 1998. SETTING A total of 661 community and tertiary care hospitals in the United States. SUBJECTS A cohort of 27,080 consecutive patients with acute MI associated with
ST-segment elevation or left bundle-branch block who were treated with primary
angioplasty. MAIN OUTCOME MEASURE In-hospital mortality, compared by time from acute MI symptom onset
to first balloon inflation and by time from hospital arrival to first balloon
inflation (door-to-balloon time). RESULTS Using a multivariate logistic regression model, the adjusted odds of
in-hospital mortality did not increase significantly with increasing delay
from MI symptom onset to first balloon inflation. However, for door-to-balloon
time (median time 1 hour 56 minutes), the adjusted odds of mortality were
significantly increased by 41% to 62% for patients with door-to-balloon times
longer than 2 hours (for 121-150 minutes: odds ratio [OR], 1.41; 95% confidence
interval [CI], 1.08-1.84; P=.01; for 151-180 minutes:
OR, 1.62; 95% CI, 1.23-2.14; P180
minutes: OR, 1.61; 95% CI, 1.25-2.08; P |
| doi_str_mv | 10.1001/jama.283.22.2941 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_71209289</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>192779</ama_id><sourcerecordid>71209289</sourcerecordid><originalsourceid>FETCH-LOGICAL-a370t-7827c77d45f01b5aba79d55ebda20abf677fe7a1fa5dc8e335402a99f4e18b343</originalsourceid><addsrcrecordid>eNplkU9v1DAUxC0EosvCHS7IQohbtv4Tr-3jUkqp1KoIWnGMXhJ765VjB9s57DfpxyVVt6pE3-Ud5qfRaAah95SsKCH0eAcDrJjiK8ZWTNf0BVpQwVXFhVYv0YIQrSpZq_oIvcl5R-ajXL5GR5SotWCSLtDdL-OhuBjyrRtxtPj3fhhLHKqrkE2pSqy-gvcxBnztBoMh9PhbjOmZ8MeVW3wZUwHvyh67gH_OtiaUjG9Cb9I2urDFm7B1cfSQZ8TGhDfdVAy-3McOUu_A4_NgIXX3ed6iVxZ8Nu8Of4luvp9en_yoLq7Ozk82FxVwSUolFZOdlH0tLKGtgBak7oUwbQ-MQGvXUlojgVoQfacM56ImDLS2taGq5TVfoi8PvmOKfyeTSzO43BnvIZg45UZSRjRTegY__Qfu4pTCnK1hdK51vVb3bh8P0NQOpm_G5AZI--ax8Bn4fAAgd-BtgtC5_MRxLet5wiX68IDNAz-Jmkmp-T8tKZov</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211376684</pqid></control><display><type>article</type><title>Relationship of Symptom-Onset-to-Balloon Time and Door-to-Balloon Time With Mortality in Patients Undergoing Angioplasty for Acute Myocardial Infarction</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Cannon, Christopher P ; Gibson, C. Michael ; Lambrew, Costas T ; Shoultz, David A ; Levy, Drew ; French, William J ; Gore, Joel M ; Weaver, W. Douglas ; Rogers, William J ; Tiefenbrunn, Alan J</creator><creatorcontrib>Cannon, Christopher P ; Gibson, C. Michael ; Lambrew, Costas T ; Shoultz, David A ; Levy, Drew ; French, William J ; Gore, Joel M ; Weaver, W. Douglas ; Rogers, William J ; Tiefenbrunn, Alan J</creatorcontrib><description>CONTEXT Rapid time to treatment with thrombolytic therapy is associated with
lower mortality in patients with acute myocardial infarction (MI). However,
data on time to primary angioplasty and its relationship to mortality are
inconclusive. OBJECTIVE To test the hypothesis that more rapid time to reperfusion results in
lower mortality in the strategy of primary angioplasty. DESIGN Prospective observational study of data collected from the Second National
Registry of Myocardial Infarction between June 1994 and March 1998. SETTING A total of 661 community and tertiary care hospitals in the United States. SUBJECTS A cohort of 27,080 consecutive patients with acute MI associated with
ST-segment elevation or left bundle-branch block who were treated with primary
angioplasty. MAIN OUTCOME MEASURE In-hospital mortality, compared by time from acute MI symptom onset
to first balloon inflation and by time from hospital arrival to first balloon
inflation (door-to-balloon time). RESULTS Using a multivariate logistic regression model, the adjusted odds of
in-hospital mortality did not increase significantly with increasing delay
from MI symptom onset to first balloon inflation. However, for door-to-balloon
time (median time 1 hour 56 minutes), the adjusted odds of mortality were
significantly increased by 41% to 62% for patients with door-to-balloon times
longer than 2 hours (for 121-150 minutes: odds ratio [OR], 1.41; 95% confidence
interval [CI], 1.08-1.84; P=.01; for 151-180 minutes:
OR, 1.62; 95% CI, 1.23-2.14; P<.001; and for >180
minutes: OR, 1.61; 95% CI, 1.25-2.08; P<.001). CONCLUSIONS The relationship in our study between increased mortality and delay
in door-to-balloon time longer than 2 hours (present in nearly 50% of this
cohort) suggests that physicians and health care systems should work to minimize
door-to-balloon times and that door-to-balloon time should be considered when
choosing a reperfusion strategy. Door-to-balloon time also appears to be a
valid quality-of-care indicator.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.283.22.2941</identifier><identifier>PMID: 10865271</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Aged ; Angioplasty ; Angioplasty, Balloon, Coronary ; Biological and medical sciences ; Blood. Blood coagulation. Reticuloendothelial system ; Emergency Medical Services ; Female ; Heart attacks ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Mortality ; Multivariate Analysis ; Myocardial Infarction - mortality ; Myocardial Infarction - therapy ; Outcome Assessment (Health Care) ; Pharmacology. Drug treatments ; Prospective Studies ; Time Factors</subject><ispartof>JAMA : the journal of the American Medical Association, 2000-06, Vol.283 (22), p.2941-2947</ispartof><rights>2000 INIST-CNRS</rights><rights>Copyright American Medical Association Jun 14, 2000</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a370t-7827c77d45f01b5aba79d55ebda20abf677fe7a1fa5dc8e335402a99f4e18b343</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.283.22.2941$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.283.22.2941$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3327,27901,27902,76231,76234</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1397415$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10865271$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cannon, Christopher P</creatorcontrib><creatorcontrib>Gibson, C. Michael</creatorcontrib><creatorcontrib>Lambrew, Costas T</creatorcontrib><creatorcontrib>Shoultz, David A</creatorcontrib><creatorcontrib>Levy, Drew</creatorcontrib><creatorcontrib>French, William J</creatorcontrib><creatorcontrib>Gore, Joel M</creatorcontrib><creatorcontrib>Weaver, W. Douglas</creatorcontrib><creatorcontrib>Rogers, William J</creatorcontrib><creatorcontrib>Tiefenbrunn, Alan J</creatorcontrib><title>Relationship of Symptom-Onset-to-Balloon Time and Door-to-Balloon Time With Mortality in Patients Undergoing Angioplasty for Acute Myocardial Infarction</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>CONTEXT Rapid time to treatment with thrombolytic therapy is associated with
lower mortality in patients with acute myocardial infarction (MI). However,
data on time to primary angioplasty and its relationship to mortality are
inconclusive. OBJECTIVE To test the hypothesis that more rapid time to reperfusion results in
lower mortality in the strategy of primary angioplasty. DESIGN Prospective observational study of data collected from the Second National
Registry of Myocardial Infarction between June 1994 and March 1998. SETTING A total of 661 community and tertiary care hospitals in the United States. SUBJECTS A cohort of 27,080 consecutive patients with acute MI associated with
ST-segment elevation or left bundle-branch block who were treated with primary
angioplasty. MAIN OUTCOME MEASURE In-hospital mortality, compared by time from acute MI symptom onset
to first balloon inflation and by time from hospital arrival to first balloon
inflation (door-to-balloon time). RESULTS Using a multivariate logistic regression model, the adjusted odds of
in-hospital mortality did not increase significantly with increasing delay
from MI symptom onset to first balloon inflation. However, for door-to-balloon
time (median time 1 hour 56 minutes), the adjusted odds of mortality were
significantly increased by 41% to 62% for patients with door-to-balloon times
longer than 2 hours (for 121-150 minutes: odds ratio [OR], 1.41; 95% confidence
interval [CI], 1.08-1.84; P=.01; for 151-180 minutes:
OR, 1.62; 95% CI, 1.23-2.14; P<.001; and for >180
minutes: OR, 1.61; 95% CI, 1.25-2.08; P<.001). CONCLUSIONS The relationship in our study between increased mortality and delay
in door-to-balloon time longer than 2 hours (present in nearly 50% of this
cohort) suggests that physicians and health care systems should work to minimize
door-to-balloon times and that door-to-balloon time should be considered when
choosing a reperfusion strategy. Door-to-balloon time also appears to be a
valid quality-of-care indicator.</description><subject>Aged</subject><subject>Angioplasty</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Emergency Medical Services</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - therapy</subject><subject>Outcome Assessment (Health Care)</subject><subject>Pharmacology. Drug treatments</subject><subject>Prospective Studies</subject><subject>Time Factors</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplkU9v1DAUxC0EosvCHS7IQohbtv4Tr-3jUkqp1KoIWnGMXhJ765VjB9s57DfpxyVVt6pE3-Ud5qfRaAah95SsKCH0eAcDrJjiK8ZWTNf0BVpQwVXFhVYv0YIQrSpZq_oIvcl5R-ajXL5GR5SotWCSLtDdL-OhuBjyrRtxtPj3fhhLHKqrkE2pSqy-gvcxBnztBoMh9PhbjOmZ8MeVW3wZUwHvyh67gH_OtiaUjG9Cb9I2urDFm7B1cfSQZ8TGhDfdVAy-3McOUu_A4_NgIXX3ed6iVxZ8Nu8Of4luvp9en_yoLq7Ozk82FxVwSUolFZOdlH0tLKGtgBak7oUwbQ-MQGvXUlojgVoQfacM56ImDLS2taGq5TVfoi8PvmOKfyeTSzO43BnvIZg45UZSRjRTegY__Qfu4pTCnK1hdK51vVb3bh8P0NQOpm_G5AZI--ax8Bn4fAAgd-BtgtC5_MRxLet5wiX68IDNAz-Jmkmp-T8tKZov</recordid><startdate>20000614</startdate><enddate>20000614</enddate><creator>Cannon, Christopher P</creator><creator>Gibson, C. Michael</creator><creator>Lambrew, Costas T</creator><creator>Shoultz, David A</creator><creator>Levy, Drew</creator><creator>French, William J</creator><creator>Gore, Joel M</creator><creator>Weaver, W. Douglas</creator><creator>Rogers, William J</creator><creator>Tiefenbrunn, Alan J</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>20000614</creationdate><title>Relationship of Symptom-Onset-to-Balloon Time and Door-to-Balloon Time With Mortality in Patients Undergoing Angioplasty for Acute Myocardial Infarction</title><author>Cannon, Christopher P ; Gibson, C. Michael ; Lambrew, Costas T ; Shoultz, David A ; Levy, Drew ; French, William J ; Gore, Joel M ; Weaver, W. Douglas ; Rogers, William J ; Tiefenbrunn, Alan J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a370t-7827c77d45f01b5aba79d55ebda20abf677fe7a1fa5dc8e335402a99f4e18b343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Aged</topic><topic>Angioplasty</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Emergency Medical Services</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - therapy</topic><topic>Outcome Assessment (Health Care)</topic><topic>Pharmacology. Drug treatments</topic><topic>Prospective Studies</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cannon, Christopher P</creatorcontrib><creatorcontrib>Gibson, C. Michael</creatorcontrib><creatorcontrib>Lambrew, Costas T</creatorcontrib><creatorcontrib>Shoultz, David A</creatorcontrib><creatorcontrib>Levy, Drew</creatorcontrib><creatorcontrib>French, William J</creatorcontrib><creatorcontrib>Gore, Joel M</creatorcontrib><creatorcontrib>Weaver, W. 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Michael</au><au>Lambrew, Costas T</au><au>Shoultz, David A</au><au>Levy, Drew</au><au>French, William J</au><au>Gore, Joel M</au><au>Weaver, W. Douglas</au><au>Rogers, William J</au><au>Tiefenbrunn, Alan J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Relationship of Symptom-Onset-to-Balloon Time and Door-to-Balloon Time With Mortality in Patients Undergoing Angioplasty for Acute Myocardial Infarction</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2000-06-14</date><risdate>2000</risdate><volume>283</volume><issue>22</issue><spage>2941</spage><epage>2947</epage><pages>2941-2947</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>CONTEXT Rapid time to treatment with thrombolytic therapy is associated with
lower mortality in patients with acute myocardial infarction (MI). However,
data on time to primary angioplasty and its relationship to mortality are
inconclusive. OBJECTIVE To test the hypothesis that more rapid time to reperfusion results in
lower mortality in the strategy of primary angioplasty. DESIGN Prospective observational study of data collected from the Second National
Registry of Myocardial Infarction between June 1994 and March 1998. SETTING A total of 661 community and tertiary care hospitals in the United States. SUBJECTS A cohort of 27,080 consecutive patients with acute MI associated with
ST-segment elevation or left bundle-branch block who were treated with primary
angioplasty. MAIN OUTCOME MEASURE In-hospital mortality, compared by time from acute MI symptom onset
to first balloon inflation and by time from hospital arrival to first balloon
inflation (door-to-balloon time). RESULTS Using a multivariate logistic regression model, the adjusted odds of
in-hospital mortality did not increase significantly with increasing delay
from MI symptom onset to first balloon inflation. However, for door-to-balloon
time (median time 1 hour 56 minutes), the adjusted odds of mortality were
significantly increased by 41% to 62% for patients with door-to-balloon times
longer than 2 hours (for 121-150 minutes: odds ratio [OR], 1.41; 95% confidence
interval [CI], 1.08-1.84; P=.01; for 151-180 minutes:
OR, 1.62; 95% CI, 1.23-2.14; P<.001; and for >180
minutes: OR, 1.61; 95% CI, 1.25-2.08; P<.001). CONCLUSIONS The relationship in our study between increased mortality and delay
in door-to-balloon time longer than 2 hours (present in nearly 50% of this
cohort) suggests that physicians and health care systems should work to minimize
door-to-balloon times and that door-to-balloon time should be considered when
choosing a reperfusion strategy. Door-to-balloon time also appears to be a
valid quality-of-care indicator.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>10865271</pmid><doi>10.1001/jama.283.22.2941</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 2000-06, Vol.283 (22), p.2941-2947 |
| issn | 0098-7484 1538-3598 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_71209289 |
| source | MEDLINE; American Medical Association Journals |
| subjects | Aged Angioplasty Angioplasty, Balloon, Coronary Biological and medical sciences Blood. Blood coagulation. Reticuloendothelial system Emergency Medical Services Female Heart attacks Hospital Mortality Humans Logistic Models Male Medical sciences Middle Aged Mortality Multivariate Analysis Myocardial Infarction - mortality Myocardial Infarction - therapy Outcome Assessment (Health Care) Pharmacology. Drug treatments Prospective Studies Time Factors |
| title | Relationship of Symptom-Onset-to-Balloon Time and Door-to-Balloon Time With Mortality in Patients Undergoing Angioplasty for Acute Myocardial Infarction |
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