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Total Ischemic Time Versus Door-To-Balloon Time As An Outcome Predictor In St-Elevation Myocardial Infarction

Cite this:
Sigal, MD, A., Rajagopalan, MD, P., Fadahunsi, MD, O., Koslow, MD, M., Wasser, PhD, T., Mengel, RN, V. C., & Barbera, MD, C. (2018). Total Ischemic Time Versus Door-To-Balloon Time As An Outcome Predictor In St-Elevation Myocardial Infarction. Journal of Medical Biomedical and Applied Sciences, 6(6), 67–72. https://doi.org/10.15520/jmbas.v6i6.121
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Abstract

BACKGROUND
Acute Coronary Syndrome is a common presenting condition to the emergency department and early reperfusion
therapy for patients with an ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention is the
recommended treatment. The American Heart Association / American College of Cardiology has a 60 minutes goal for
restoration of coronary flow from the time of patient arrival.
OBJECTIVE
To review the impact of rapidly identifying STEMI patients and expediting transfer to the interventional cardiology suite
on restoration of blood flow times and metrics of cardiac injury, such as peak troponin and ejection fraction. To review
the impact of total ischemic time on similar metrics.
METHODS
We conducted a single site retrospective review on STEMI patients undergoing the expedited process for reperfusion
compared to standard process.
RESULTS
Expedited transfer of patients to the cardiac catheterization suite resulted in significantly lower door-to-balloon times for
patients undergoing the “drive-by†process (mean 31.03, SD 4.05 vs mean 68.72, SD 45.09, p < 0.001), compared to
usual care. The improved times, however, did not translate into improved metrics of peak troponin value or LVEF. There
was a significantly lower peak troponin level (mean 57.14, SD 86.51 vs 97.73, SD 152.43, p=0.017) and a greater LVEF
percent at six months (56.41, SD 10.46 vs 52.56, SD 11.93, p = 0.039) for those with < 4 hour symptoms than those
with 4 hours of symptoms.
CONCLUSION
Symptom onset to balloon time has a greater impact on cardiac morbidity than door-to-balloon time.

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