Impact of Delay in Door-to-Needle Time on Mortality in Patients With ST-Segment Elevation Myocardial Infarction
Fibrinolytic therapy is the most common reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI), particularly in smaller centers. Previous studies evaluated the relation between time to treatment and outcomes when few patients were treated within 30 minutes of hospi...
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| Veröffentlicht in: | The American journal of cardiology 2007-10, Vol.100 (8), p.1227-1232 |
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| creator | McNamara, Robert L., MD, MHS Herrin, Jeph, PhD Wang, Yongfei, MS Curtis, Jeptha P., MD Bradley, Elizabeth H., PhD Magid, David J., MD, MPH Rathore, Saif S., MPH Nallamothu, Brahmajee K., MD, MPH Peterson, Eric D., MD, MPH Blaney, Martha E., PharmD Frederick, Paul, PhD Krumholz, Harlan M., MD, SM |
| description | Fibrinolytic therapy is the most common reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI), particularly in smaller centers. Previous studies evaluated the relation between time to treatment and outcomes when few patients were treated within 30 minutes of hospital arrival and many did not receive modern adjunctive medications. To quantify the impact of a delay in door-to-needle time on mortality in a recent and representative cohort of patients with STEMI, a cohort of 62,470 patients with STEMI treated using fibrinolytic therapy at 973 hospitals that participated in the National Registry of Myocardial Infarction from 1999 to 2002 was analyzed. Hierarchical models were used to evaluate the independent effect of door-to-needle time on in-hospital mortality. In-hospital mortality was lower with shorter door-to-needle times (2.9% for ≤30 minutes, 4.1% for 31 to 45 minutes, and 6.2% for >45 minutes; p |
| doi_str_mv | 10.1016/j.amjcard.2007.05.043 |
| format | Article |
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Previous studies evaluated the relation between time to treatment and outcomes when few patients were treated within 30 minutes of hospital arrival and many did not receive modern adjunctive medications. To quantify the impact of a delay in door-to-needle time on mortality in a recent and representative cohort of patients with STEMI, a cohort of 62,470 patients with STEMI treated using fibrinolytic therapy at 973 hospitals that participated in the National Registry of Myocardial Infarction from 1999 to 2002 was analyzed. Hierarchical models were used to evaluate the independent effect of door-to-needle time on in-hospital mortality. In-hospital mortality was lower with shorter door-to-needle times (2.9% for ≤30 minutes, 4.1% for 31 to 45 minutes, and 6.2% for >45 minutes; p <0.001 for trend). Compared with those experiencing door-to-needle times ≤30 minutes, adjusted odd ratios (ORs) of dying were 1.17 (95% confidence interval [CI] 1.04 to 1.31) and 1.37 (95% CI 1.23 to 1.52; p for trend <0.001) for patients with door-to-needle times of 31 to 45 and >45 minutes, respectively. This relation was particularly pronounced in those presenting within 1 hour of symptom onset to presentation time (OR 1.25, 95% CI 1.01 to 1.54; OR 1.54, 95% CI 1.27 to 1.87, respectively; p for trend <0.001). In conclusion, timely administration of fibrinolytic therapy continues to significantly impact on mortality in the modern era, particularly in patients presenting early after symptom onset.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2007.05.043</identifier><identifier>PMID: 17920362</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Arrhythmias, Cardiac - complications ; Biological and medical sciences ; California - epidemiology ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Cohort Studies ; Coronary heart disease ; Emergency Service, Hospital - standards ; Emergency Service, Hospital - statistics & numerical data ; Emergency Treatment - utilization ; Female ; Fibrinolytic Agents - administration & dosage ; Heart ; Heart attacks ; Hospital Mortality ; Humans ; Male ; Medical Records ; Medical sciences ; Medical treatment ; Mortality ; Myocardial Infarction - complications ; Myocardial Infarction - drug therapy ; Myocardial Infarction - epidemiology ; Myocardial Infarction - mortality ; Myocardial Infarction - pathology ; Myocarditis. Cardiomyopathies ; Outcome Assessment (Health Care) ; Registries ; Retrospective Studies ; Thrombolytic Therapy - utilization ; Time and Motion Studies ; Time Factors</subject><ispartof>The American journal of cardiology, 2007-10, Vol.100 (8), p.1227-1232</ispartof><rights>Elsevier Inc.</rights><rights>2007 Elsevier Inc.</rights><rights>2007 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. Oct 15, 2007</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c577t-e373c4d495ed32e8c5f8e73ccf36a2df453417597903d687df7ed95b2ecb1e553</citedby><cites>FETCH-LOGICAL-c577t-e373c4d495ed32e8c5f8e73ccf36a2df453417597903d687df7ed95b2ecb1e553</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.amjcard.2007.05.043$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19174782$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17920362$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McNamara, Robert L., MD, MHS</creatorcontrib><creatorcontrib>Herrin, Jeph, PhD</creatorcontrib><creatorcontrib>Wang, Yongfei, MS</creatorcontrib><creatorcontrib>Curtis, Jeptha P., MD</creatorcontrib><creatorcontrib>Bradley, Elizabeth H., PhD</creatorcontrib><creatorcontrib>Magid, David J., MD, MPH</creatorcontrib><creatorcontrib>Rathore, Saif S., MPH</creatorcontrib><creatorcontrib>Nallamothu, Brahmajee K., MD, MPH</creatorcontrib><creatorcontrib>Peterson, Eric D., MD, MPH</creatorcontrib><creatorcontrib>Blaney, Martha E., PharmD</creatorcontrib><creatorcontrib>Frederick, Paul, PhD</creatorcontrib><creatorcontrib>Krumholz, Harlan M., MD, SM</creatorcontrib><title>Impact of Delay in Door-to-Needle Time on Mortality in Patients With ST-Segment Elevation Myocardial Infarction</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Fibrinolytic therapy is the most common reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI), particularly in smaller centers. Previous studies evaluated the relation between time to treatment and outcomes when few patients were treated within 30 minutes of hospital arrival and many did not receive modern adjunctive medications. To quantify the impact of a delay in door-to-needle time on mortality in a recent and representative cohort of patients with STEMI, a cohort of 62,470 patients with STEMI treated using fibrinolytic therapy at 973 hospitals that participated in the National Registry of Myocardial Infarction from 1999 to 2002 was analyzed. Hierarchical models were used to evaluate the independent effect of door-to-needle time on in-hospital mortality. In-hospital mortality was lower with shorter door-to-needle times (2.9% for ≤30 minutes, 4.1% for 31 to 45 minutes, and 6.2% for >45 minutes; p <0.001 for trend). Compared with those experiencing door-to-needle times ≤30 minutes, adjusted odd ratios (ORs) of dying were 1.17 (95% confidence interval [CI] 1.04 to 1.31) and 1.37 (95% CI 1.23 to 1.52; p for trend <0.001) for patients with door-to-needle times of 31 to 45 and >45 minutes, respectively. This relation was particularly pronounced in those presenting within 1 hour of symptom onset to presentation time (OR 1.25, 95% CI 1.01 to 1.54; OR 1.54, 95% CI 1.27 to 1.87, respectively; p for trend <0.001). In conclusion, timely administration of fibrinolytic therapy continues to significantly impact on mortality in the modern era, particularly in patients presenting early after symptom onset.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arrhythmias, Cardiac - complications</subject><subject>Biological and medical sciences</subject><subject>California - epidemiology</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cohort Studies</subject><subject>Coronary heart disease</subject><subject>Emergency Service, Hospital - standards</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Emergency Treatment - utilization</subject><subject>Female</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Medical Records</subject><subject>Medical sciences</subject><subject>Medical treatment</subject><subject>Mortality</subject><subject>Myocardial Infarction - complications</subject><subject>Myocardial Infarction - drug therapy</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - pathology</subject><subject>Myocarditis. Cardiomyopathies</subject><subject>Outcome Assessment (Health Care)</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Thrombolytic Therapy - utilization</subject><subject>Time and Motion Studies</subject><subject>Time Factors</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk1v1DAQhiMEokvhJ4AsJLgl-COOk0sr1BZYqXxIu4ij5bUnrYMTL3Z2pf33OGzUQi-cLM88Hr8z72TZS4ILgkn1ritU32kVTEExFgXmBS7Zo2xBatHkpCHscbbAGNO8IWVzkj2LsUtXQnj1NDshoqGYVXSR-WW_VXpEvkWX4NQB2QFdeh_y0edfAIwDtLY9ID-gzz6MytnxD_NNjRaGMaIfdrxFq3W-gps-BdCVg33KTfzBT_qscmg5tCroKfo8e9IqF-HFfJ5m3z9crS8-5ddfPy4v3l_nmgsx5sAE06UpGw6GUag1b2tIId2ySlHTlpyVRPBGNJiZqhamFWAavqGgNwQ4Z6fZ2bHudrfpwegkLSgnt8H2KhykV1b-mxnsrbzxe0kF4WkyqcDbuUDwv3YQR9nbqME5NYDfRVnVjJOS1wl8_QDs_C4MqTlJWRqywKJMED9COvgYA7R3SgiWk5-yk7OfcvJTYi6Tn-ndq7_buH81G5iANzOgolauDWrQNt5zDRGlqCfu_MhBGvreQpBRJwM1GBtAj9J4-18pZw8qaGcHmz79CQeId00TGanEcjUt37R7WGDCGKnZb-FC1oc</recordid><startdate>20071015</startdate><enddate>20071015</enddate><creator>McNamara, Robert L., MD, MHS</creator><creator>Herrin, Jeph, PhD</creator><creator>Wang, Yongfei, MS</creator><creator>Curtis, Jeptha P., MD</creator><creator>Bradley, Elizabeth H., PhD</creator><creator>Magid, David J., MD, MPH</creator><creator>Rathore, Saif S., MPH</creator><creator>Nallamothu, Brahmajee K., MD, MPH</creator><creator>Peterson, Eric D., MD, MPH</creator><creator>Blaney, Martha E., PharmD</creator><creator>Frederick, Paul, PhD</creator><creator>Krumholz, Harlan M., MD, SM</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20071015</creationdate><title>Impact of Delay in Door-to-Needle Time on Mortality in Patients With ST-Segment Elevation Myocardial Infarction</title><author>McNamara, Robert L., MD, MHS ; Herrin, Jeph, PhD ; Wang, Yongfei, MS ; Curtis, Jeptha P., MD ; Bradley, Elizabeth H., PhD ; Magid, David J., MD, MPH ; Rathore, Saif S., MPH ; Nallamothu, Brahmajee K., MD, MPH ; Peterson, Eric D., MD, MPH ; Blaney, Martha E., PharmD ; Frederick, Paul, PhD ; Krumholz, Harlan M., MD, SM</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c577t-e373c4d495ed32e8c5f8e73ccf36a2df453417597903d687df7ed95b2ecb1e553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arrhythmias, Cardiac - complications</topic><topic>Biological and medical sciences</topic><topic>California - epidemiology</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cohort Studies</topic><topic>Coronary heart disease</topic><topic>Emergency Service, Hospital - standards</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Emergency Treatment - utilization</topic><topic>Female</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Medical Records</topic><topic>Medical sciences</topic><topic>Medical treatment</topic><topic>Mortality</topic><topic>Myocardial Infarction - complications</topic><topic>Myocardial Infarction - drug therapy</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - pathology</topic><topic>Myocarditis. 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Previous studies evaluated the relation between time to treatment and outcomes when few patients were treated within 30 minutes of hospital arrival and many did not receive modern adjunctive medications. To quantify the impact of a delay in door-to-needle time on mortality in a recent and representative cohort of patients with STEMI, a cohort of 62,470 patients with STEMI treated using fibrinolytic therapy at 973 hospitals that participated in the National Registry of Myocardial Infarction from 1999 to 2002 was analyzed. Hierarchical models were used to evaluate the independent effect of door-to-needle time on in-hospital mortality. In-hospital mortality was lower with shorter door-to-needle times (2.9% for ≤30 minutes, 4.1% for 31 to 45 minutes, and 6.2% for >45 minutes; p <0.001 for trend). Compared with those experiencing door-to-needle times ≤30 minutes, adjusted odd ratios (ORs) of dying were 1.17 (95% confidence interval [CI] 1.04 to 1.31) and 1.37 (95% CI 1.23 to 1.52; p for trend <0.001) for patients with door-to-needle times of 31 to 45 and >45 minutes, respectively. This relation was particularly pronounced in those presenting within 1 hour of symptom onset to presentation time (OR 1.25, 95% CI 1.01 to 1.54; OR 1.54, 95% CI 1.27 to 1.87, respectively; p for trend <0.001). In conclusion, timely administration of fibrinolytic therapy continues to significantly impact on mortality in the modern era, particularly in patients presenting early after symptom onset.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>17920362</pmid><doi>10.1016/j.amjcard.2007.05.043</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The American journal of cardiology, 2007-10, Vol.100 (8), p.1227-1232 |
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| source | MEDLINE; Access via ScienceDirect (Elsevier) |
| subjects | Aged Aged, 80 and over Arrhythmias, Cardiac - complications Biological and medical sciences California - epidemiology Cardiology Cardiology. Vascular system Cardiovascular Cohort Studies Coronary heart disease Emergency Service, Hospital - standards Emergency Service, Hospital - statistics & numerical data Emergency Treatment - utilization Female Fibrinolytic Agents - administration & dosage Heart Heart attacks Hospital Mortality Humans Male Medical Records Medical sciences Medical treatment Mortality Myocardial Infarction - complications Myocardial Infarction - drug therapy Myocardial Infarction - epidemiology Myocardial Infarction - mortality Myocardial Infarction - pathology Myocarditis. Cardiomyopathies Outcome Assessment (Health Care) Registries Retrospective Studies Thrombolytic Therapy - utilization Time and Motion Studies Time Factors |
| title | Impact of Delay in Door-to-Needle Time on Mortality in Patients With ST-Segment Elevation Myocardial Infarction |
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