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(Circulation. 2006;113:1048-1050.)
© 2006 American Heart Association, Inc.

Editorial

Door-to-Balloon Time in Primary Percutaneous Coronary Intervention

Is the 90-Minute Gold Standard an Unreachable Chimera?

Mauro Moscucci, MD; Kim A. Eagle, MD

From the Department of Internal Medicine, Division of Cardiology, University of Michigan Health System, Ann Arbor.

Correspondence to Kim A. Eagle, MD, University of Michigan Cardiovascular Center, 300 N Ingalls, 8B02, Ann Arbor, MI 48109-0477. E-mail keagle@umich.edu

Key Words: Editorials • myocardial infarction • reperfusion • stents • survival

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Over the past decade, primary percutaneous coronary intervention (PCI) has emerged as an effective treatment strategy for acute ST-segment–elevation myocardial infarction (STEMI). Compared with thrombolytic therapy, the benefits of primary PCI include a reduction in the frequency of total stroke and hemorrhagic stroke, a reduction in the frequency of reinfarction, and an increase in the frequency of infarct-related artery patency, resulting in improved in-hospital and long-term survival.¹ In addition, the availability of primary PCI provides a valid alternative for patients who have contraindications to thrombolytic therapy. Article p 1079

These observations have led many institutions to select primary PCI as the preferred treatment strategy for patients with acute STEMI. In addition, after the publication of several reports on the safety and efficacy of primary PCI in centers without cardiac surgery on site,^2,3 several state regulatory agencies have changed local regulations by allowing primary PCI for acute STEMI in centers without cardiac surgery on site. Thus, it is likely that the next decade will be characterized by further expansion of primary PCI for acute STEMI in hospitals with cardiac catheterization laboratories.

As previously shown for thrombolytic therapy, time to treatment also plays a key role in survival with primary PCI. In the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IIb) substudy,⁴ the lowest 30-day mortality rate was observed in patients undergoing primary PCI within 60 minutes from presentation to the emergency room, whereas the highest mortality rate was observed in patients undergoing PCI >90 minutes from . . . [Full Text of this Article]