Death and nonfatal reinfarction within the first 24 hours after presentation with an acute coronary syndrome: Experience from GUSTO-IIb☆,☆☆,★,★★
Section snippets
Trial design
The design and primary outcome variables of GUSTO-IIb have been described.9 Briefly, patients with ischemic symptoms occurring at rest and lasting at least 10 minutes were eligible if the electrocardiogram taken at presentation revealed ST-segment deviation (elevation or depression) of >1 mm and if enrollment could occur within 12 hours of the onset of pain. Patients with ST-segment elevation and pain for more than 30 minutes could receive reperfusion therapy with either thrombolytics or
Results
Of the 12,142 patients enrolled, status at 24 hours could be ascertained in 12,139. Death or myocardial (re)infarction occurred within 24 hours in 210 patients (1.7%). These events represented 19% of the 1135 deaths or (re)infarctions that occurred within 30 days. Table I shows baseline demographic characteristics of patients who had either of these events within the first 24 hours.
Empty Cell Time to death or (re)infarction <24 hours (n = 210) 24 hours to 30
Timing of events according to presenting syndrome
In this study we have distinguished the courses of early events in patients with and without ST-segment elevation after presentation with acute chest pain. Early events, particularly deaths, were more common among patients with ST-segment elevation on their presenting electrocardiogram than among those without ST-segment elevation and among patients with myocardial infarction at enrollment compared with those with unstable angina.
These differences likely reflect several factors. First, the
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Cited by (0)
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Supported by grants from Ciba-Geigy (Summit, NJ), Boehringer Mannheim (Indianapolis, Ind), and Advanced Cardiovascular Systems (Mountain View, Calif).
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Dr. Christopher Cannon from Brigham and Women’s Hospital, Boston, Mass, acted as Guest Editor for this manuscript.
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Reprint requests: Neal S. Kleiman, MD, Methodist Hospital, 6565 Fannin, MS F1090, Houston, Texas 77030.E-mail: [email protected]
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