Is Shorter Door-to-Balloon Time Associated with a Double Risk of Major Adverse Cardiac Events? Use of Drug-Eluting Stents Should Be Considered.

Abstract

Ischemic time duration is directly related to myocardial injury and mortality in ST-elevation myocardial infarction (STEMI). While longer door-to-balloon (DTB) time is associated with increased mortality, efforts to lower DTB time have not always translated into decreased mortality.1 In the recent issue of Acta Cardiologica Sinica, Lai et al. divided STEMI patients into four groups by each 45-minute interval of DTB time. The results showed that patients with DTB time 45 minutes mainly resulted from composites of target vessel revascularizations (TVR) and repeated percutaneous coronary interventions. However, we noted that patients with DTB < 45 minutes received a reduced rate of drug-eluting stents (DES) implantation than other groups (13.9% vs. 17.3%, 21.8% and 20.7%, respectively, p = 0.04). In the same registry, the use of DES over bare metal stents showed benefits in one-year mortality, TVR and MACE;3 which implied that different types of stents may have varied clinical impacts. It is important to elucidate whether the significant relationship between 1-year MACE and DTB time < 45 minutes remains after adjusting for use of DES. In our five-year acute coronary syndrome cohort, DTB time was significantly correlated with one-year mortality in 951 STEMI patients undergoing primary PCI (Table 1). This suggested that DTB time is still an important prognostic factor, especially when ischemic time is not long.4 Table 1 Risk factors associated with one-year mortality in patients with STEMI undergoing primary percutaneous interventions by logistic Cox-proportional hazard analysis