That squeeze in your chest? Don't delay.
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https://medicalxpress.com/news/2021-01-quickly-heart-symptoms-saver.html
The longer the time between when heart attack symptoms start and a patient has an artery-clearing percutaneous coronary intervention (PCI), the more damage to the heart muscle, according to new research published today in Circulation: Cardiovascular Interventions.
A heart attack happens about every 40 seconds in the U.S., and the most common heart attack is caused by a complete blockage in a coronary artery, called ST-elevation myocardial infarction (STEMI). STEMI patients are most often treated with PCI, also known as angioplasty with stent, in which a catheter with a deflated balloon is inserted into the narrowed heart artery. Subsequently, the balloon is inflated, which clears the obstruction and restores blood flow. A stent is then inserted to keep the artery open.
"We know the time to opening the blocked coronary artery with PCI in heart attack patients is an important indicator for how a patient does after their heart attack. There are two measures for this time. One is symptom-to-balloon time, which is before the patient arrives to the hospital after symptoms start, to when that patient has a PCI; second is door-to-balloon time, the time from hospital arrival to PCI," said study author Gregg W. Stone, M.D., director of academic affairs at Mount Sinai Heart Health System in New York City. "We focused on heart attack size, or damage, with both time measures and found symptom-to-balloon time was by far the more important."
Stone and colleagues analyzed the data from 10 randomized controlled trials that followed more than 3,100 STEMI patients enrolled after PCI between 2002-2011. Patients' hearts were assessed within between 3-12 days after PCI to measure the size of the heart attack, and some studies also included measures of ejection fraction (a measure of the percentage of blood the heart is able to pump with each contraction) and TIMI flow (a measure of blood flow in the coronary artery). All patients had clinical follow-up data for at least six months, with a median follow-up of 341 days after PCI.
The study found:
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Symptom-to-balloon time was more strongly associated with heart attack size and patients' clinical health after heart attack than door-to-balloon time.
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The median symptom-to-balloon time was 185 minutes. The median door-to-balloon time was 46 minutes.
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Symptom-to-balloon time represented approximately 80% of the total time from symptom onset to treatment of the artery.
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The size of the heart attack increased with longer symptom-to-balloon times, whereas longer door-to-balloon times were not notably related to heart attack size.
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Older age, female sex, arterial hypertension, diabetes and left circumflex artery as the culprit vessel were associated with longer symptom-to-balloon time.
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For every 60-minute delay in symptom-to-balloon time, the one-year rate of death or hospitalization for heart failure was increased by 11%. In contrast, there was no relationship between delays in door-to-balloon time and these clinical results.
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Door-to-balloon time is the time from ED to procedure or from OR to procedure?
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https://www.ahajournals.org/doi/abs/10.1161/CIRCINTERVENTIONS.120.009879
Results: Median [IQR] SBT and DBT were 185 [130-269] and 46 [28-83] minutes, respectively. Median [IQR] time to infarct size assessment after pPCI was 5 [3-12] days. There was a stepwise increase in infarct size according to SBT category (adjusted difference 2.0%, 95% confidence interval [CI] 0.4-3.5 for intermediate versus short SBT and 4.4%, 95%CI 2.7-6.1 for long versus short SBT) but not according to DBT category category (adjusted difference 0.4%, 95% CI -1.2 to 1.9 for intermediate versus short DBT and -0.1%, 95% CI -1.0 to 3.0 for long versus short SBT). MVO was greater in patients with long versus short SBT (adjusted difference 0.9%; 95% CI 0.3-1.4) but was not different between patients with intermediate versus short SBT (adjusted difference 0.1; 95% CI -0.4 to 0.6). There was no difference in MVO according to DBT. Results were similar in multivariable analysis with SBT and DBT included as continuous variables.
Conclusions: Among 3115 patients with STEMI undergoing infarct size assessment after pPCI, SBT was more strongly correlated with infarct size and MVO than DBT.
If I had to guess, I'd stay that the reason that DBT plays less of a role is that once you hit the ER, therapy is started, whereas if you delay with your symptoms, damage is ongoing.
