title: Therapy-dependent influence of time-to-treatment interval on myocardial salvage in patients with acute myocardial infarction treated with coronary artery stenting or thrombolysis.
abstract: BACKGROUND
  The relationship between myocardial salvage and time-to-treatment interval in patients with acute myocardial infarction (AMI) treated with coronary artery stenting or thrombolysis has not been studied.
  
  
  RESULTS
  This study analyzed 264 patients with AMI randomized to coronary stenting (133 patients) or thrombolysis (131 patients) in the setting of 2 randomized trials. Patients were divided into the following 3 groups defined by tertiles of the time-to-treatment interval: lower tertile (<165 minutes), middle tertile (165 to 280 minutes), and upper tertile (>280 minutes). Paired scintigraphic examinations were performed to obtain salvage index, which was the primary end point of the study. In the group with thrombolysis, the salvage index (median [25th; 75th] percentile) was 0.45 (0.16; 0.83) in the lower, 0.29 (0.17; 0.48) in the middle, and 0.20 (0.04; 0.46) in the upper tertile (P=0.03). In the group with stenting, the salvage index was 0.56 (0.49; 0.75) in the lower, 0.57 (0.36; 0.73) in the middle, and 0.57 (0.32; 0.75) in the upper tertile (P=0.59). In patients treated with stenting, the salvage index was greater than in patients treated with thrombolysis in the lower (0.56 versus 0.45, P=0.09), middle (0.57 versus 0.29, P=0.0003), and upper (0.57 versus 0.20, P=0.0005) tertiles of the time-to-treatment interval.
  
  
  CONCLUSIONS
  The influence of the time-to-treatment interval on the myocardial salvage in patients with AMI depends on the type of reperfusion therapy. Coronary artery stenting was superior to thrombolysis independent of the time-to-treatment intervals, and the difference in benefit increased with more prolonged time from symptom onset.
authors.affiliation: Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, München, Germany. aschoemig@dhm.mhn.de
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
authors.forename: Markus
authors.initials: M
authors.lastname: Schwaiger
authors.forename: Helmut
authors.initials: H
authors.lastname: Schühlen
authors.forename: Stephan
authors.initials: S
authors.lastname: Nekolla
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pache
authors.forename: Stefan
authors.initials: S
authors.lastname: Martinoff
authors.forename: Hildegard
authors.initials: H
authors.lastname: Bollwein
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
mesh_terms: D000368:Aged; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D009204:Myocardial Revascularization; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015607:Stents; D017256:Technetium Tc 99m Sestamibi; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi