Risk assessment of coronary artery bypass grafting within one month of acute myocardial infarction
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, 1 November 1988, Pages 964-966
Risk assessment of coronary artery bypass grafting within one month of acute myocardial infarction
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From the Department of Surgery, Division of Cardiothoracic Surgery, 303 East Chicago Avenue, Ward 9-105, Northwestern University Medical School, Chicago, Illinois 60611 USA
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Since 1974, when Dawson et al1 documented an extremely high operative mortality in a large series of patients who had coronary artery bypass grafting (CABG) within 30 days of acute myocardial infarction (AMI), controversy has existed concerning the proper timing of such procedures. Widely varying mortality rates still appear in recently published reports, but several studies have been carried out that report mortality rates as low as ≤1%.2–5 Because most of these studies do not detail whether the infarcts were transmural or nontransmural, we attempted to determine whether operative mortality could be correlated with the type of infarct and the timing of CABG after the infarct.
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Fax: +33 (0)3 83 50 46 66Faire une nouvelle rechercheMake a new searchTitre du document / Document titleRisk assessment of coronary artery bypass fragting within one month of acute myocardial infarctionAuteur(s) / Author(s) (1) ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)(1) Div. cardiothoracic surgery, dep. surgery, Chicago IL 60611, ETATS-UNISRevue / Journal Title
CODEN AJCDAG
Source / Source1988, vol. 62, no13, pp. 964-966 (8 ref.)Langue / LanguageAnglaisEditeur / PublisherElsevier, New York, NY, ETATS-UNIS
(Revue)Mots-clés anglais / English Keywords ;
Mots-clés fran?ais / French Keywords ;
Mots-clés espagnols / Spanish Keywords ;
Localisation / LocationINIST-CNRS, Cote INIST : 8674
N? notice refdoc (ud4) : 6983567Faire une nouvelle rechercheMake a new searchRelationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction.
Cannon CP, et al. JAMA. 2000.
JAMA. 2000 Jun 14;283(22):2941-7.
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.
Prospective observational study of data collected from the Second National Registry of Myocardial Infarction between June 1994 and March 1998.
A total of 661 community and tertiary care hospitals in the United States.
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).
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. JAMA. 2000.
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