Therapeutic delay and reduced functional status six months after thrombolysis for acute myocardial infarction
| Autor: | David A. Ganz, Eric L. Knight, Jerry Avorn, Sebastian Schneeweiss |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Male
Risk medicine.medical_specialty Time Factors medicine.medical_treatment Myocardial Infarction Disability Evaluation Patient Admission Fibrinolytic Agents Multicenter trial Internal medicine Activities of Daily Living Humans Medicine Thrombolytic Therapy In patient Prospective Studies Myocardial infarction Aged Likelihood Functions business.industry Mortality rate Thrombolysis Middle Aged medicine.disease Survival Analysis United States Confidence interval Index score Logistic Models Tissue Plasminogen Activator Cardiology Female Functional status Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The American Journal of Cardiology. 94:415-420 |
| ISSN: | 0002-9149 |
| DOI: | 10.1016/j.amjcard.2004.04.055 |
| Popis: | Thrombolytic therapy decreases the mortality rate in patients with acute myocardial infarction (AMI), and the timing of thrombolysis has proved to be critical for decreasing the short-term mortality rate. Much less is known about the longer term consequences of delays in thrombolysis, particularly for outcomes other than the mortality rate. We assessed the effect of time to thrombolysis and other clinical predictors on cardiac functional status 6 months after AMI. We used InTIME II, a multicenter trial, to test the efficacy of alteplase and lanoteplase. This component of the trial was conducted in 147 North American centers. Patients wereor =18 years of age with ST-elevated AMI. Functional status was measured by the Duke Activity Status Index, which was administered 6 months after AMI. After multivariate adjustment for baseline characteristics, delay in presentation to hospital and delay in initiation of thrombolysis were significantly and independently associated with decreased cardiac functional status 6 months later. Each additional hour from symptom onset to hospital presentation was associated with a 16% increase (95% confidence interval 3% to 31%) in the likelihood of functional impairment (Duke Activity Status Index scoreor =30). In addition, each additional delay of 1 hour from hospital presentation to thrombolysis independently increased the probability of functional impairment by 38% (12% to 71%). Thus, in patients with AMI, earlier presentation to the hospital and more rapid initiation of thrombolysis could prevent significant decreases in functional status months after the initial infarct. |
| Databáze: | OpenAIRE |
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