Impact of the time from symptoms onset to thrombolysis on in-hospital major adverse cardiovascular event rate in patients with acute ST-segment elevation myocardial infarction

Abstract

To explore the impact of thrombolytic therapy time delay on in-hospital major adverse cardiac event rate in patients with acute ST-segment elevation myocardial infarction (STEMI). This survey was performed in 101 level 2 hospitals from 15 provinces or autonomous region in China. Patients admitted to these hospitals with acute STEMI during November 2011 to November 2014 and received thrombolytic therapy were eligible for this study. Multivariate logistic regression modeling was used to estimate the rate of in-hospital major adverse cardiac events (re-infarction, stroke and all-cause mortality) in patients with different thrombolytic time delay. A total of 3 719 STEMI patients received thrombolytic therapy, 88%(3 270 cases) of them were treated within 12 hours. After controlling for the impact of confounding factors, such as a variety of risk factors, past disease histories, the severity of STEMI, medication, interventions, etc, MACE rates significantly increased along with the thrombolysis time delay, no matter thrombolysis succeeded or not (trend test P<0.05). In group of successful thrombolysis, multivariate adjusted rate of MACE for 0-5.9 hours, 6.0-11.9 hours and ≥12.0 hours were 3.2%, 3.9% and 7.8%; in group of unsuccessful thrombolysis, it was 11.6%, 14.1% and 25.2% respectively (trend test P<0.05). The multivariate adjusted rates of re-infarction in group of successful thrombolysis as well as in group of unsuccessful thrombolysis significantly increased in proportion to thrombolysis time delay ≥ 12.0 h (trend test P<0.05). In group of successful thrombolysis, multivariate adjusted rate of re-infarction for 0-5.9 hours, 6.0-11.9 hours and ≥12.0 hours were 1.9%, 1.5% and 6.8%; in group of unsuccessful thrombolysis, it was 3.9%, 3.1% and 13.6%, respectively. Within the same time delay group, MACE and re-infarction rates were significantly lower in successful thrombolysis group than in unsuccessful thrombolysis group (all P<0.05). Thrombolytic therapy should be conducted within 6 hours after the attack. Both re-infarction or MACE rates are significantly increased in patients with more than 12 hours thrombolysis time delay.