From the Guidelines
The PCI recommended cut-off point of 120 minutes is based on the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, which states that interhospital transfer to a PCI-capable hospital is the recommended triage strategy if primary PCI can be performed within 120 minutes of first medical contact (FMC) 1. This guideline is crucial in the management of ST-elevation myocardial infarction (STEMI) as it emphasizes the importance of timely restoration of coronary blood flow to minimize myocardial tissue death. The 120-minute threshold is supported by an analysis of approximately 19,000 propensity score–matched patients with STEMI, which showed that delays related to transfer for primary PCI exceeding 120 minutes from FMC negated the survival advantage of primary PCI over fibrinolysis 1. Key points to consider in this context include:
- The importance of minimizing transfer delays to ensure that primary PCI can be performed within the recommended 120-minute time frame 1.
- The use of fibrinolytic therapy as an alternative reperfusion strategy when primary PCI cannot be performed within the 120-minute window, especially in facilities without PCI capabilities 1.
- The emphasis on the "time is muscle" concept, which recognizes that shorter door-to-balloon times correlate with improved patient outcomes, reduced mortality, and better preservation of cardiac function following a heart attack 1. While other studies, such as the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, also discuss the importance of timely primary PCI, the 2013 ACCF/AHA guideline provides the most recent and highest-quality evidence to support the 120-minute cut-off point 1.
From the Research
PCI Recommended Cut Off Point
The PCI recommended cut off point is related to the door-to-balloon time, which is the time from the patient's arrival at the hospital to the time of balloon inflation in the coronary artery.
- The American College of Cardiology and American Heart Association recommend a door-to-balloon time of 90 minutes or less for patients undergoing primary percutaneous coronary intervention (PCI) 2.
- However, the question asks about a 120-minute cut off point, which is not directly mentioned in the provided studies.
- One study mentions that a door-in to door-out (DIDO) time of 30 minutes or less is recommended to expedite reperfusion care, and the median DIDO time was 68 minutes (interquartile range, 43-120 minutes) 3.
- This suggests that a DIDO time of 120 minutes or less may be considered acceptable in some cases, but it is not a specific recommended cut off point for PCI.
Studies on PCI Timing
- A study published in 2009 found that transfer for PCI within 6 hours after fibrinolysis was associated with significantly fewer ischemic complications than standard treatment 4.
- Another study published in 2011 found that a DIDO time of 30 minutes or less was associated with shorter reperfusion delays and lower in-hospital mortality 3.
- A study published in 2013 found that median door-to-balloon times declined significantly from 83 minutes to 67 minutes, but in-hospital mortality remained virtually unchanged 2.
- These studies suggest that timely PCI is important for improving outcomes in patients with acute myocardial infarction, but the optimal timing and recommended cut off points may vary depending on the specific clinical context.