Primary Percutaneous Coronary Intervention The Deception of Delay ⁎ ⁎

Primary percutaneous coronary intervention (PCI) has become the predominant reperfusion strategy for ST-segment elevation myocardial infarction (STEMI) throughout western healthcare systems. Recent estimates in the United States suggest that primary PCI is used in 85% of all STEMI cases that undergo reperfusion, with thrombolytic agents used in only 9% and the combination of thrombolytic agents with PCI in 6% (1). This dramatic switch from thrombolytic therapy to primary PCI was the result of several studies conducted in the early 1990s that demonstrated the superiority of primary PCI at reducing stroke and reinfarction as well as an absolute reduction in mortality by 2% (2). These benefits were achieved despite a median door-to-balloon time (D2BT) of 120 min in many of the studies (3). The ability to achieve early and complete reperfusion is important, with additional prognostic factors including age, comorbidities, previous myocardial infarction or congestive heart failure, and infarct size. Early reports demonstrated that prolonged D2BTs were associated with worse survival (4,5,6,7); however, little attention was paid to the fact that sicker patients have more delay. Moreover, the marked differences in survival could not have been due simply to a delay in reperfusion (40% reduction in survival with a 30-min delay) (4) because these mortality differences were greater than what would be expected if the patient never had reperfusion (8,9).
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - Category: Cardiology Source Type: research