778-4 Is Primary Angioplasty Less Effective in Patients with Acute Myocardial Infarction Presenting in the Early Morning Hours?

• Published in: Journal of the American College of Cardiology Vol. 25; no. 2; p. 295A
• Main Authors: Stone, Gregg W., Grines, Cindy L., Browne, Kevin F., Marco, Jean, Rothbaum, Donald, O’Keefe, James, Overlie, Paul, Donohue, Brian, Puchrowicz, Sylvia, O’Neill, William W.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.02.1995
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)92682-U

Concern has been expressed that delays in physician and cath lab mobilization may adversely affect the feasibility and outcome of a primary angioplasty strategy in pts with acute MI presenting in the early morning hours. In the PAMI Trial, 395 pts within 12 hours onset of MI were prospectively randomized to t-PA (n=200) vs. primary PTCA (n = 195). Demographic characteristics were similar between pts presenting between 12 MN and 6 AM (Group A) and 6 AM to 12 MN (Group B). Outcomes appear below:Time (mins)PTCAt-PAGroup A (n=36)Group B (n=159)Group A In=38)Group B (n=162)chest pain onset to randomization211±129173±116*258±179183±139†randomization to t-PA bolusN/AN/A34±2531±22randomization to cath lab arrival43±2039±18N/AN/Acath lab arrival to first angiogram21±920±11N/AN/Afirst angiogram to reperfusion19±1420±24N/AN/AHospital eventsPTCA success91.7%94.3%N/AN/ADeath5.6%1,9%7,9%6.2%Death or reinfarction13.4%3.1%§18.4%105%£Recurrent ischemia16.7%88%£34.2%26.5%*p<0.09†P=0.005§p=0.008£p<0.18All other p = NS Time to presentation is prolonged in pts with MI in the early morning hours. No delays occur, however, in cath lab mobilization, PTCA performance or success. Further studies are required to explain the apparently worse prognosis of pts presenting between 12 MN and 6AM in this trial.