OBJECTIVES: To examine the impact of time to thrombolytic treatment on multiple acute outcome variables in a single trial of thrombolysis in acute myocardial infarction. DESIGN AND PATIENTS: Mortality and reinfarction rate were measured in 2770 patients with acute myocardial infarction who received thrombolysis within 12 hours in CORE, an international, dose ranging trial of poloxamer 188. Tc-99m sestamibi infarct size and radionuclide angiographic ejection fraction substudies included 1099 and 1074 patients, respectively. RESULTS: Time to thrombolysis, subgrouped by intervals (< 2, 2-4, > or = 4-6, and > or = 6 hours), was significantly associated with infarct size (median 15.0%, 18.5%, 22.0%, 18.5% of left ventricle; p = 0.033), mean (SD) ejection fraction (51.5 (12.0)%, 48. 3 (13.9)%, 48.2 (13.3)%, 48.2 (15.0)%; p = 0.006), 35 day mortality (5.7%, 7.1%, 7.9%, 12.5%; p = 0.0004), six month mortality (7.3%, 8. 6%, 10.4%, 15.5%; p < 0.0001), and 35 day reinfarction rate (6.1%, 3. 2%, 4.0%, 0.9%; p = 0.0001). CONCLUSIONS: In this single large trial, the beneficial effect of time to thrombolysis on infarct size and ejection fraction was restricted to treatment given within two hours of symptom onset, while the effect on mortality was evident over all time intervals. Reinfarction rate was higher in patients treated with earlier thrombolysis.
RCT Entities:
OBJECTIVES: To examine the impact of time to thrombolytic treatment on multiple acute outcome variables in a single trial of thrombolysis in acute myocardial infarction. DESIGN AND PATIENTS: Mortality and reinfarction rate were measured in 2770 patients with acute myocardial infarction who received thrombolysis within 12 hours in CORE, an international, dose ranging trial of poloxamer 188. Tc-99m sestamibiinfarct size and radionuclide angiographic ejection fraction substudies included 1099 and 1074 patients, respectively. RESULTS: Time to thrombolysis, subgrouped by intervals (< 2, 2-4, > or = 4-6, and > or = 6 hours), was significantly associated with infarct size (median 15.0%, 18.5%, 22.0%, 18.5% of left ventricle; p = 0.033), mean (SD) ejection fraction (51.5 (12.0)%, 48. 3 (13.9)%, 48.2 (13.3)%, 48.2 (15.0)%; p = 0.006), 35 day mortality (5.7%, 7.1%, 7.9%, 12.5%; p = 0.0004), six month mortality (7.3%, 8. 6%, 10.4%, 15.5%; p < 0.0001), and 35 day reinfarction rate (6.1%, 3. 2%, 4.0%, 0.9%; p = 0.0001). CONCLUSIONS: In this single large trial, the beneficial effect of time to thrombolysis on infarct size and ejection fraction was restricted to treatment given within two hours of symptom onset, while the effect on mortality was evident over all time intervals. Reinfarction rate was higher in patients treated with earlier thrombolysis.
Authors: F H Sheehan; E Braunwald; P Canner; H T Dodge; J Gore; P Van Natta; E R Passamani; D O Williams; B Zaret Journal: Circulation Date: 1987-04 Impact factor: 29.690
Authors: Santanu Guha; Rishi Sethi; Saumitra Ray; Vinay K Bahl; S Shanmugasundaram; Prafula Kerkar; Sivasubramanian Ramakrishnan; Rakesh Yadav; Gaurav Chaudhary; Aditya Kapoor; Ajay Mahajan; Ajay Kumar Sinha; Ajit Mullasari; Akshyaya Pradhan; Amal Kumar Banerjee; B P Singh; J Balachander; Brian Pinto; C N Manjunath; Chandrashekhar Makhale; Debabrata Roy; Dhiman Kahali; Geevar Zachariah; G S Wander; H C Kalita; H K Chopra; A Jabir; JagMohan Tharakan; Justin Paul; K Venogopal; K B Baksi; Kajal Ganguly; Kewal C Goswami; M Somasundaram; M K Chhetri; M S Hiremath; M S Ravi; Mrinal Kanti Das; N N Khanna; P B Jayagopal; P K Asokan; P K Deb; P P Mohanan; Praveen Chandra; Col R Girish; O Rabindra Nath; Rakesh Gupta; C Raghu; Sameer Dani; Sandeep Bansal; Sanjay Tyagi; Satyanarayan Routray; Satyendra Tewari; Sarat Chandra; Shishu Shankar Mishra; Sibananda Datta; S S Chaterjee; Soumitra Kumar; Soura Mookerjee; Suma M Victor; Sundeep Mishra; Thomas Alexander; Umesh Chandra Samal; Vijay Trehan Journal: Indian Heart J Date: 2017-03-23
Authors: D Rimar; E Crystal; A Battler; S Gottlieb; D Freimark; H Hod; V Boyko; L Mandelzweig; S Behar; J Leor Journal: Heart Date: 2002-10 Impact factor: 5.994