Cardiology Medical News about door-to-balloon time, microvascular perfusion, myocardial blush grade

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Relation between door-to-balloon time and microvascular perfusion as evaluated by myocardial blush grade, corrected TIMI frame count, and ST-segment resolution in treatment of acute myocardial infarction
Journal of Interventional Cardiology, 08/14/09

Lee C-H et al. – Door-to-balloon time >90 min, vs ≤90 min, was independently associated with myocardial blush grade (MBG), 01/2 and CTFC >28, both suggesting microvascular obstruction. This association was not found in ST-segment resolution. Pts with door-to-balloon time >90 min also had higher 30-day mortality.

Methods

Study to compare microvascular perfusion in pts who had primary percutaneous coronary intervention with door-to-balloon time ≤90 min vs >90 min
MBG, corrected TIMI frame count (CTFC), and ST-segment resolution to assess microvascular perfusion
Subjects: 297 pts who had successful primary percutaneous coronary intervention between January 2007-April 2008

Results

Door-to-balloon time ≤90 min in 199 (67%) pts and >90 min in 98 (33%) pts
Univariate analysis: door-to-treatment >90 min associated with MBG 0/1 and CTFC >28 but not with ST-segment resolution ≤70%
After adjustment for baseline confounding factors, door-to-balloon time >90 min remained associated with MBG 0/1 and CTFC >28
Higher 30-day mortality in pts with longer door-to-balloon time

Exclusive Author Commentary
Ronald C.H. Lee, 08/16/09

Previous registry studies documented an "association" between long door-to-balloon time and high mortality. This study provides a mechanistic explanation for the observation. Our findings supports the commitment of hospitals to setting door-to-balloon time ?90 minutes as a clinical quality indictor and implementing strategies to achieve this target.

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