[Effects of delay in onset of revascularisation strategies in the acute phase of myocardial infarction].
BACKGROUND
thrombolysis (THL) and primary percutaneous coronary intervention (PCI) are therapeutic options in acute myocardial infarction (MI). These strategies have similar efficiency, particularly in the early phase. However, in these randomized studies, different times to treatment (TT) threshold are recognized as discriminant.


OBJECTIVE
to validate, on a one year mortality criteria the best TT threshold in the real life.


METHODS
794 patients, admitted directly in our institution with a Ml< or =12 hours; 299 were treated by THL and 495 by PCI. The primary end-point was 1-year mortality according to TT and strategy of revascularization. Three TT thresholds were tested (120, 150 and 180 min) to define the best strategy of revascularisation.


RESULTS
only the 150 min TT threshold showed a significant difference between the two strategies. If TT was less than 150 min, relative risk of 1-year mortality was 1.36 (p=0.62) for patients treated by THL compared to those treated with PCI. By contrast, the relative risk of one year mortality was 1.95 if Tr was greater than 150 min (p=0.02).


CONCLUSIONS
TT is a key factor to define the best strategy of reperfusion. The critical threshold seems to be at 150 min. THL should be considered as a therapeutic choice only if administered within the first 150 min. After this delay, primary PCI should be preferred.
de Labriolle
A
A
Département de cardiologie, CHU de Tours, hôpital Trousseau, avenue de la République, 37170 Chambray-les-Tours. a.delabriolle@chu-tours.fr
Pacouret
G
G
Bertrand
P
P
Barbey
C
C
Magdelaine
B
B
Desveaux
B
B
Quilliet
L
L
Fauchier
L
L
Charbonnier
B
B
D015906:Angioplasty, Balloon, Coronary; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors