Impact of Prolonged Door-to-Balloon Times on the Diastolic Function in Acute ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.
BACKGROUND
Emerging evidence indicates that diastolic left ventricular (LV) function is a powerful outcome predictor after acute ST-elevation myocardial infarction (STEMI). We hypothesized that shorter door-to-balloon (D2B) times with early restoration of coronary perfusion may preserve diastolic LV function in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).


METHODS
This study enrolled 340 consecutive STEMI patients who underwent PPCI with D2B times of < 90 min in 232 patients and D2B times ≥ 90 min in 108 patients, who all received subsequent echocardiographic examination within 48 hours of hospitalization.


RESULTS
Although the LV ejection fraction was similar (50.92% vs. 51.66%, p = 0.573), the proportion of E/E' ratio > 15 was greater in patients with D2B times ≥ 90 min compared to those with D2B times < 90 min (44.4% vs. 30.6%, p = 0.013). Logistic regression analysis revealed that D2B time ≥ 90 min [odds ratio (OR): 1.82, 95% confidence interval (Cl): 1.04-3.17, p = 0.035] was an independent predictor for LV diastolic dysfunction. The effect was more prominent in patients ≥ 65 years of age (OR: 2.77, 95% CI: 1.09-7.00, p = 0.032), in whom the fraction of LV diastolic dysfunction increased proportionally with prolonged D2B times.


CONCLUSIONS
Prolonged D2B time of greater than 90 min predicted LV diastolic dysfunction, particularly in aged subjects. D2B times shortening is important to preserve diastolic heart function after PPCI.


BACKGROUND
Acute myocardial infarction; Diastolic dysfunction; Door-to-balloon time; Primary percutaneous coronary intervention.
Graduate Institute of Clinical Medical Science, China Medical University; ; Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
Yu-Chen
YC
Wang
Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
Hung-Pin
HP
Wu
Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
Ping-Hang
PH
Lo
Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
Hsin-Yueh
HY
Liang
Graduate Institute of Clinical Medical Science, China Medical University; ; Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
Kuan-Cheng
KC
Chang