Prognostic impact of non-compliance with guidelines-recommended times to reperfusion therapy in ST-elevation myocardial infarction. The FAST-MI 2010 registry.

Aims:Current guidelines recommend short time delays from qualifying ECG to reperfusion therapy in ST-elevation myocardial infarction (STEMI) patients. Recently, however, it has been suggested that shortening door-to-balloon times might not result in lower mortality, thereby questioning the relevance of current guidelines. The aim of this study was to assess in-hospital and one-year mortality in patients with fibrinolysis or primary percutaneous coronary intervention (PPCI) according to guidelines-recommended times to reperfusion therapy.Methods and results:FAST-MI 2010 is a nationwide French registry including 4169 patients, of whom 1580 had ST-elevation myocardial infarction and had PPCI (n=1289) or fibrinolysis (n=291) as part of a pharmaco-invasive strategy. Four groups were constituted: Gr1 (within recommended times from ECG to PPCI; n=708), Gr2 (beyond recommended times from ECG to PPCI; n=581), Gr3 (time from ECG to lysis ⩽30 min, n=196), and Gr4 (time from ECG to lysis >30 min, n=95). In-hospital m...