Effect of Early Door to Balloon Time on Treatment with Adjunctive Therapy and Resultant Procedural Success in STEMI

Objectives: We studied whether earlier door-to-balloon (DTB) times affected use of standard adjunct medications (Rx), and the effect of differential Rx on PCI success. Background: Striving for earlier DTB times in STEMI is important, but rushing may negatively impact pt management. We studied whether earlier DTB times negatively affected use of standard adjunct Rx, pre-PCI chest x-ray (CXR), and the effect on PCI success. Methods: 227 pts diagnosed with STEMI were taken directly for angiography. Rx use between 3 grps were compared: Grp A=DTB>90 (n=156), Grp B=DTB<90 (n=71), Grp C =DTB<60 (n=12). Differential Rx patterns were evaluated for effect on PCI success. Optimal PCI result was defined as post-PCI TIMI 3 flow and stenosis <50% in the infarct vessel. Results: Fewer pts received all Rx pre-PCI in Grp B than in Grp A, 1.4% vs. 9.6% (p=0.02), including B-blk, 53.5% vs. 67.3% (p=0.01) heparin infusion (GTT), 19.7% vs. 46.8% (p 66min) of heparin pretreatment had more optimal PCI result (65.0%), vs. Q1 (0-30min) (41.0%) (p=0.02). Pts receiving heparin GTT had optimal results 66.2% vs. 50.0% (p=0.02), and higher TIMI 3 flow (69.8% vs. 53.2%, p=0.02). In this cohort, there was no significant difference in mortality based on DTB group, though use of B-blk and IIb/IIIa medications improved mortality and cardiac mortality, respectively. Conclusion: In this cohort, earlier DTB times led to less complete adjunctive Rx and omission of diagnostic steps. Shorter pretreatment with heparin, and omission of heparin GTT, predicted less favorable procedural outcomes.