Author + information
- C. Richard Conti, MD∗ ()
- ↵∗University of Florida, Health Science Center, Room M-438, 1600 SW Archer Road, P.O. Box 100277, Gainesville, Florida 32610-0277
I was very interested to read the paper by Wilson et al. (1), relating to achieving sustainable door-to-balloon (D2B) times of 90 min for regional transfer of ST-segment elevation myocardial infarction (STEMI) patients, and I have a few comments.
First, I would like to congratulate the authors for accomplishing this task, which in my opinion is not easy to do. Second, the outcome of this investigation is D2B <90 min from the time the patient entered the transferring hospital, but I could not detect any clinical outcome results of this accomplishment.
Despite the fact that the D2B metric of <90 min was accomplished, as far as I could tell, nothing is mentioned in the paper relating to 30-day readmission rate, 30-day mortality, or 1-year mortality. The investigators do note that despite their accomplishments, length of stay and in-hospital mortality remained unchanged, compared with longer D2B times in the past.
I do not think there is any question that D2B is a metric, but can we honestly say that it is the only metric that should be measured to evaluate outcome in patients with acute STEMI?
I doubt that the investigators will be able to get this information, but it would be nice if they had some data on the duration of symptoms to balloon (S2B), because I suspect the duration of symptoms may play a role in outcome. Similarly, patients with a history of prior myocardial infarction are more likely to have a poorer outcome than those who have a first infarction. Along the same lines, current smokers and patients with renal dysfunction may be more likely to have a negative outcome than those who do not have these risk factors.
It would also be interesting to know whether or not there is a difference in outcome in females and males.
In my opinion, there is no question that D2B is an important metric, but it is not the only metric that affects outcome in STEMI patients (2). Outcome studies in STEMI patients that do not include these other metrics do not take into consideration the risk profile of the individual patient and may overestimate successful interventions in these high-risk groups.
Current STEMI therapy focuses on early reperfusion of the infarct-related artery, with the goal of a D2B time of <90 min. The investigators have accomplished that goal but have not considered other metrics that might influence outcome.
- American College of Cardiology Foundation