Door-to-Balloon Time Outperforms ST-Segment Elevation in Predicting the STEMI vs. NSTEMI Final Diagnosis

Area of Science:

• Cardiology
• Interventional Cardiology
• Acute Myocardial Infarction Research

Background:

• The classification of ST-elevation myocardial infarction (STEMI) versus non-ST-elevation myocardial infarction (NSTEMI) is crucial for guiding acute myocardial infarction (AMI) management and assessing quality metrics.
• Current diagnostic practices rely on electrocardiogram (ECG) findings, coronary angiography, and clinical assessment.

Purpose of the Study:

• To investigate whether the final cath-lab diagnosis of STEMI or NSTEMI correlates more closely with door-to-balloon (D2B) time compared to ST-segment elevation (STE) on pre-angiogram ECG or angiographic evidence of occluded culprit lesions (TIMI 0-1 flow).

Main Methods:

• A retrospective analysis of 410 patients with AMI from the DOMI-ARIGATO database who underwent coronary angiography.
• Data collected included final cath-lab diagnosis (FDx), D2B time (<120 min vs. >120 min), presence of STE on ECG, and TIMI flow grade of the culprit lesion.

Main Results:

• The final cath-lab diagnosis demonstrated a 94% agreement with D2B time, significantly higher than agreement with STE (82%) or TIMI 0-1 flow (75%).
• Discordance between final diagnosis and STE occurred in 18% of cases, with rapid D2B times driving STEMI labels even without STE.
• Door-to-balloon time less than 120 minutes was the sole independent predictor of diagnostic discordance (adjusted OR 6.7).

Conclusions:

• In this patient registry, the "STEMI" label in the cath-lab was most strongly associated with achieving a 120-minute treatment benchmark.
• The findings indicate that adherence to quality metrics, particularly rapid reperfusion times, may predominantly influence the final STEMI/NSTEMI classification over traditional electrocardiographic or angiographic criteria.