Therapy-Dependent Influence of Time-to-Treatment Interval on Myocardial Salvage in Patients With Acute Myocardial Infarction Treated With Coronary Artery Stenting or Thrombolysis
Why the study?
Does coronary artery stenting improve myocardial salvage compared to thrombolysis across different time-to-treatment intervals in patients with acute myocardial infarction?
Population
264 patients with acute myocardial infarction (AMI) pooled from 2 randomized trials
Comparison
Coronary artery stenting vs Thrombolysis
Design
Meta-analysis, Patients were randomized to coronary stenting or thrombolysis…
Authors
Discussion
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Implication
Supports primary stenting over thrombolysis with treatment delays; extends evidence for time-dependent myocardial salvage in AMI.
Key Points
- To determine how time-to-treatment intervals affect myocardial salvage in patients with acute myocardial infarction treated with coronary stenting compared with thrombolysis.
- Analyzed 264 patients with acute myocardial infarction randomized to coronary stenting (n=133) or thrombolysis (n=131) within two randomized trials.
- Categorized patients into time-to-treatment tertiles (<165 minutes, 165–280 minutes, >280 minutes) and evaluated the primary endpoint of myocardial salvage index using paired scintigraphic examinations.
- In the thrombolysis arm, median myocardial salvage index decreased significantly across increasing time tertiles from 0.45 to 0.29 to 0.20 (P=0.03), whereas it remained stable with stenting at 0.56, 0.57, and 0.57 (P=0.59).
- Stenting yielded a significantly higher salvage index compared to thrombolysis in the middle (0.57 vs 0.29, P=0.0003) and upper tertiles (0.57 vs 0.20, P=0.0005), and showed a non-significant trend in the lower tertile (0.56 vs 0.45, P=0.09).
Structured PICO
Does coronary artery stenting improve myocardial salvage compared to thrombolysis across different time-to-treatment intervals in patients with acute myocardial infarction?
P
Population
264 patients with acute myocardial infarction (AMI) pooled from 2 randomized trials
I
Intervention
Coronary artery stenting
C
Comparator
Thrombolysis
O
Outcome
Salvage index obtained by paired scintigraphic examinationssurrogate
Coronary artery stenting provides superior myocardial salvage compared to thrombolysis in acute myocardial infarction, with the magnitude of benefit increasing as the time from symptom onset to treatment is prolonged.
Cite This Study
Schömig et al. (2003) studied this question.