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Published on: December 11, 2016
Ischemic time is a better predictor than door-to-balloon time for mortality and infarct size in ST-elevation
Amirreza Solhpour1, Kay-Won Chang1, Salman A Arain1
1University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
Insights
Total ischemic time (IT) is a better predictor of mortality and infarct size in ST-elevation myocardial infarction (STEMI) patients than door-to-balloon (D2B) time. Minimizing IT is crucial for STEMI care.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- Current ST-elevation myocardial infarction (STEMI) guidelines emphasize early revascularization.
- Optimal ischemic time (IT) is <120 minutes and door-to-balloon (D2B) time is <90 minutes.
- IT is less frequently reported and studied than D2B time.
Purpose of the Study:
- To test the hypothesis that total IT is a superior predictor of mortality and infarct size compared to D2B time in STEMI patients.
- To evaluate the clinical significance of IT in STEMI management.
Main Methods:
- Retrospective analysis of 786 STEMI patients treated between December 2008 and April 2013.
- Cardiac magnetic resonance imaging (CMR) performed on 262 patients 3-5 days post-STEMI.
- Patients categorized by IT (<120, 120-239, ≥240 min) and D2B time (<30, 30-59, 60-89, ≥90 min).
Main Results:
- 30-day mortality rates significantly increased with longer IT, but not with D2B time.
- Infarct size also significantly increased with longer IT, independent of D2B time.
- Baseline demographics were comparable across IT and D2B time groups.
Conclusions:
- Total ischemic time (IT) is a more significant predictor of 30-day mortality and infarct size in STEMI patients than D2B time.
- STEMI care should prioritize minimizing IT over solely focusing on D2B time.
- Consideration of IT reporting in STEMI registries is warranted.
Background:
Current guidelines for ST-elevation myocardial infarction (STEMI) recommend early revascularization with optimal ischemic time (IT) < 120 min and door-to-balloon (D2B) time < 90 min. The focus of most studies has been D2B time, while IT is not frequently reported. We tested the hypothesis that total IT is a better predictor than D2B time for mortality and infarct size.
Methods And Results:
Between December 2008 and April 2013, 786 patients with STEMI were treated in our STEMI center, and 262 of these had cardiac magnetic resonance imaging 3-5 days after the index event. Total IT was defined as time from symptom onset to device activation, while D2B time was defined as hospital arrival to device activation. Patients were divided into three groups according to IT (<120, 120-239, ≥240 min) and into four groups according to D2B time (<30, 30-59, 60-89, ≥90 min). Baseline demographics including age, cardiac risk factors, and LAD infarct location were similar between groups. The 30-day mortality rate significantly increased across IT groups but did not correlate with D2B time groups. Similarly, infarct size significantly increased across IT groups but did not correlate with D2B time groups.
Conclusions:
In STEMI patients, IT was a better predictor than D2B time for 30-day mortality and infarct size. Our findings suggest that the focus of STEMI care should be directed at early initiation of therapy and minimizing IT rather than on D2B time alone. The potential impact of IT reporting in current STEMI registries merits further consideration. © 2015 Wiley Periodicals, Inc.
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