From the Guidelines
The PCI recommended cut-off point of 120 minutes is based on the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention 1. This guideline establishes that the systems goal of performing primary PCI within 90 min of first medical contact when the patient presents to a hospital with PCI capability, and within 120 min when the patient presents to a hospital without PCI capability. The key points to consider are:
- The guideline emphasizes the importance of timely primary PCI in patients with STEMI, with a focus on minimizing delays to maximize benefits.
- Several reports have shown excellent outcomes for patients with STEMI undergoing interhospital transfer where first medical contact–to-door balloon time modestly exceeded the systematic goal of 90 minutes 1.
- The guideline writing committees have modified the first medical contact–to-device time goal from 90 minutes to 120 minutes for interhospital transfer patients, while emphasizing that systems should continue to strive for times ≤ 90 minutes 1. Some of the benefits of primary PCI within this timeframe include:
- Lower rates for recurrent ischemia, reinfarction, emergency repeat revascularization procedures, intracranial hemorrhage, and death.
- Early, successful PCI also greatly decreases the complications of STEMI that result from longer ischemic times or unsuccessful fibrinolytic therapy, allowing earlier hospital discharge and resumption of daily activities 1.
From the Research
PCI Recommended Cut Off Point
The PCI recommended cut off point of 120 minutes is based on the study 2.
- The study found that according to current guidelines for treatment of ST-elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) should be performed within 90 min of first medical contact and total ischemic time should not exceed 120 min.
- The aim of the study was to analyze compliance with STEMI guidelines in a tertiary PCI center.
- The study analyzed a prospective single-center registry of 223 consecutive STEMI patients referred for primary PCI between 2003 and 2007.
- The results showed that median total ischemic time was 4h 30 min (<120 min in 4% of patients), indicating that only a small proportion of patients with acute myocardial infarction underwent primary PCI within the recommended time.
Comparison with Other Studies
Other studies, such as 3, 4, 5, and 6, do not specifically recommend a cut off point of 120 minutes for PCI.
- Study 3 found that longer door-to-balloon times were associated with higher 1-year mortality in a continuous, nonlinear fashion.
- Study 4 discussed antithrombotic therapy for patients with STEMI undergoing primary PCI, but did not mention a specific cut off point for PCI.
- Study 5 examined relationships between door to balloon time and subsequent admissions due to heart failure, acute coronary syndrome, and mortality for up to 1 year, but did not recommend a cut off point of 120 minutes.
- Study 6 analyzed annual trends in door-to-balloon times and in-hospital mortality, but found that despite improvements in door-to-balloon times, there was no significant overall change in unadjusted in-hospital mortality or in risk-adjusted in-hospital mortality.