From the Research
Patients achieving a door-to-balloon time of 60 minutes versus 90 minutes typically demonstrate better clinical outcomes, with reduced mortality rates and improved quality of life, as evidenced by a study published in the Journal of the American Heart Association 1. The clinical characteristics between patients achieving a door-to-balloon (DTB) time of 90 minutes versus 60 minutes are significantly different in terms of morbidity, mortality, and quality of life.
- Patients in the 60-minute group generally show:
- Lower mortality rates
- Reduced infarct size
- Better left ventricular function
- Fewer complications such as heart failure, cardiogenic shock, and arrhythmias
- The 60-minute group often experiences less myocardial damage as measured by cardiac biomarkers like troponin and CK-MB.
- These patients typically have shorter hospital stays, fewer readmissions, and better long-term survival rates. The improved outcomes in the 60-minute group are attributed to the time-dependent nature of myocardial salvage in acute myocardial infarction, where "time is muscle" 1.
- Each 30-minute reduction in reperfusion time significantly limits the extent of irreversible myocardial damage, preserves cardiac function, and reduces the risk of mechanical complications. While both timeframes fall within current guidelines, the additional 30-minute reduction to achieve a 60-minute door-to-balloon time represents a meaningful clinical advantage in the management of STEMI patients, particularly benefiting those with anterior infarctions and patients presenting early after symptom onset 1.
- A study published in the Journal of the American Heart Association found that reducing D2B time within 45 minutes showed further decreased risk of mortality compared with D2B time >90 minutes (adjusted hazard ratio, 0.30; 95% CI, 0.19-0.42; P<0.001) 1.
- Every reduction of D2B time by 30 minutes showed continuous reduction of 1-year mortality (90 to 60 minutes: absolute risk reduction, 2.4%; number needed to treat, 41.9; 60 to 30 minutes: absolute risk reduction, 2.0%; number needed to treat, 49.2) 1.