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(Circulation. 2001;104:2632.)
© 2001 American Heart Association, Inc.

Editorials

Time Is Myocardium and Time Is Outcomes

C. Michael Gibson, MS, MD

From Harvard Clinical Research Institute, Boston, Mass.

Reprint requests to C. Michael Gibson, MS, MD, Director of TIMI Data Coordinating Center and Cardiovascular Core Services, Harvard Clinical Research Institute, 900 Commonwealth Avenue, Boston, MA 02115. E-mail mgibson@perfuse.org

Key Words: Editorials • myocardial infarction • coagulation • fibrinolysis

As an interventional cardiologist and a clinical trialist, I am often asked, "what do we need to do to improve mortality by another 1% in the setting of acute myocardial infarction?" Indeed, nearly a decade and a half of effort and many hundreds of millions of dollars have been spent in pursuit of this elusive "1% reduction" in mortality by both the pharmaceutical and the device industry. As the report by the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT 2) investigators in the present issue of Circulation highlights, ¹ this kind of advance may not be achieved exclusively with new drugs or devices, but in also reducing time to treatment and in modifying patient behavior to seek these potentially life-saving treatments earlier.

See p 2653

Time and the ECG: Complementary Risk Stratification Tools

In a time of dizzying advances in diagnostic modalities, it is refreshing to see what a useful, simple, noninvasive, broadly accessible, easily repeatable/applied, and affordable tool the ECG is. ¹ Time to treatment and ST-segment resolution were roughly similar in their ability to risk-stratify patients in the study by Fu et al.¹ For both time to treatment and ST-segment resolution, there was an 2-fold gradient between the lowest risk category and the highest risk category (<2 hours versus >4 hours for time to treatment and >70% resolution versus <30% resolution for ST-segment resolution). Although time to treatment may reflect the extent of necrosis before therapy (with greater myocardial salvage observed with shorter times to treatment), ST-segment resolution may instead reflect the response to . . . [Full Text of this Article]

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