Door-to-balloon time in primary percutaneous coronary intervention predicts degree of myocardial necrosis as measured using cardiac biomarkers.

Abstract

Reduced door-to-balloon time in primary percutaneous coronary intervention for the treatment of ST-elevation myocardial infarction has been associated with lower cardiac mortality rates. However, it remains unclear whether door-to-balloon time is predominantly a surrogate for overall peri-myocardial infarction care and is not independently predictive of outcomes, particularly when differences in door-to-balloon time have narrowed and previous studies have contained myocardial infarction-selection bias.We analyzed 179 consecutive patients who presented emergently at our cardiac catheterization laboratory with ST-elevation myocardial infarction within 12 hours of symptom onset and who underwent primary percutaneous coronary intervention within 3 hours of presentation. Our curve estimation regression model used the natural logarithm (ln) of area under the curve (AUC) of creatine kinase to evaluate the effect of door-to-balloon time on cardiac biomarker levels. We correlated ln (AUC-creatine kinase) with improvement of left ventricular ejection fraction at follow-up and with the intermediate-term mortality rate.Median door-to-balloon time was 87 minutes (interquartile range, 65-113 min). The ln (AUC-creatine kinase) correlated significantly with door-to-balloon time (r=0.2, P=0.02). Upon propensity-score analysis, door-to-balloon time remained a significant independent predictor of ln (AUC-creatine kinase) (beta=0.15, P=0.03). Upon use of a Cox regression model, ln (AUC-creatine kinase) independently predicted death (P=0.04) and recovery of left ventricular function (P=0.001) at follow-up (mean, 14 mo).Longer door-to-balloon time independently predicts increased myocardial cell damage, and ln (AUC-creatine kinase) predicts improvement in left ventricular systolic function and intermediate-term death after ST-elevation myocardial infarction.

• Authors: Robert M Minutello, Luke Kim, Smita Aggarwal, Linda J Cuomo, Dmitriy N Feldman, S Chiu Wong
• Journal: Texas Heart Institute journal (Tex Heart Inst J) Vol. 37 Issue 2 Pg. 161-5 ( 2010) ISSN: 1526-6702 [Electronic] United States
• PMID: 20401287 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Creatine Kinase

Topics

• Aged
• Angioplasty, Balloon, Coronary (adverse effects, mortality)
• Area Under Curve
• Biomarkers (blood)
• Creatine Kinase (blood)
• Female
• Health Services Accessibility
• Humans
• Linear Models
• Male
• Middle Aged
• Myocardial Infarction (blood, drug therapy, mortality, pathology, physiopathology)
• Myocardium (enzymology, pathology)
• Necrosis
• Propensity Score
• Proportional Hazards Models
• Quality Indicators, Health Care
• Recovery of Function
• Registries
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome
• Ventricular Function, Left