Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction - Results from the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IIb) Trial

Background-Time to treatment with thrombolytic therapy is a critical determ inant of mortality in acute myocardial infarction. Little is known about th e relationship between the time to treatment with direct coronary angioplas ty and clinical outcome. The objectives of this study were to determine bot h the time required to perform direct coronary angioplasty in the Global Us e of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUST O-IIb) trial and its relationship to clinical outcome. Methods and Results-Patients randomized to direct coronary angioplasty (n = 565) were divided into groups based on the time between study enrollment a nd first balloon inflation, Patients randomized to angioplasty who did not undergo the procedure were also analyzed. The median time from study enroll ment to first balloon inflation was 76 minutes; 19% of patients assigned to angioplasty did not undergo an angioplasty procedure, The 30-day mortality rate of patients who underwent balloon inflation less than or equal to 60 minutes after study enrollment was 1.0%; 61 to 75 minutes after enrollment, 3.7%; 76 to 90 minutes after enrollment, 4.0%; and greater than or equal t o 91 minutes after enrollment, 6.4%. The mortality rate of patients assigne d to angioplasty who never underwent the procedure was 14.1% (P = 0.001), L ogistic regression analysis revealed that the time from enrollment to first balloon inflation was a significant predictor of mortality within 30 days; after adjustment for differences in baseline characteristics, the odds of death increased 1.6 times (P = 0.008) for a movement from each time interva l to the next. Conclusions-The time to treatment with direct PTCA, as with thrombolytic th erapy, is a critical determinant of mortality.