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Updated: Jul 10, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
A time-to-treatment analysis in the medicine versus angiography in thrombolytic exclusion (MATE) trial
P A McCullough1, W W O'Neill, M Graham
1University of Missouri-Kansas City School of Medicine, Truman Medical Center, 2301 Holmes Street, Kansas City, MO 64108, USA. mcculloughp@umkc.edu
Insights
Early angiography within 6 hours of symptom onset significantly reduces adverse events in high-risk acute coronary syndrome patients ineligible for thrombolysis. This intervention improves outcomes compared to delayed or conventional care.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Trials
Background:
- Patients with acute coronary syndromes (ACS) ineligible for thrombolytic therapy face high risks of recurrent ischemia and mortality.
- Timely intervention is crucial for improving outcomes in ACS patients.
Purpose of the Study:
- To evaluate the impact of early triage angiography versus conventional medical care on adverse events in high-risk ACS patients.
- To determine the optimal timing for angiography in this patient population.
Main Methods:
- A randomized trial involving 201 patients with ACS.
- Patients were assigned to either early triage angiography (within 24 hours) or conventional medical care.
- Analysis focused on 165 patients who underwent angiography, examining event rates based on timing from symptom onset.
Main Results:
- Angiography within 6 hours of symptom onset was associated with reduced early and late adverse events.
- In-hospital recurrent ischemia rates showed a significant trend (P=0.01) with earlier angiography.
- Cumulative rates of recurrent myocardial infarction or death did not show a significant trend with timing (P=0.48).
Conclusions:
- Performing angiography within 6 hours of symptom onset appears beneficial for high-risk ACS patients.
- Future trials comparing invasive and conservative strategies should prioritize early angiography.
Abstract:
Patients with acute coronary syndromes who are considered ineligible for thrombolytic therapy are at high risk of recurrent ischemia and death. This trial randomized 201 patients to triage angiography in the first 24 hours of hospital admission versus conventional medical care. Of the 165 patients who underwent angiography that was either protocol-driven or on the basis of physician preference, those who underwent angiography within 6 hours of symptom onset had a reduction in early and late adverse events. The rates of in-hospital recurrent ischemia were 15.4%, 15.4%, 17.5%, 32.4%, and 38.5%, respectively (P = 0.01 for trend), and rates of cumulative recurrent myocardial infarction or death were 0%, 12.8%, 10.0%, 11.8%, and 7.7%, respectively (P = 0.48 for trend) for patients who underwent angiography at 0-6, 6-12, 12-24, 24-48, and over 48 hours, respectively from symptom onset. Future trials of invasive versus conservative therapy should focus on performing angiography within 6 hours of symptom onset.
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