Georges J-L, Ben-Hadj I, Gibault-Genty G, Blicq E, Aziza J-P, Ben-Jemaa K, Moro J, Koukabi M, Livarek B
Service de cardiologie, hôpital André-Mignot, Le-Chesnay cedex, France.
Ann Cardiol Angeiol (Paris). 2011 Nov;60(5):244-51. doi: 10.1016/j.ancard.2011.07.014. Epub 2011 Aug 12.
In patients with acute ST-segment elevation myocardial infarction (STEMI), recent clinical guidelines recommend that primary percutaneous coronary intervention (PCI) should be performed within 90min of first medical contact or 45min after admission in cathlab. The Door-to-Balloon time (D2B) is widely used to measure the performance of interventional centres.
To analyze the time to reperfusion in a consecutive series of STEMI patients referred for primary PCI, and to evaluate the clinical accuracy of D2B in primary PCI.
From January 2007 to March 2008, 177 patients were admitted within 12hours of a STEMI in our institution, and 87 were referred for a direct coronary angiography for primary PCI (47 by mobile medical emergency unit, 40 by the emergency department of the institution).
The median time from first medical contact to balloon inflation (M2B) was 135min [IQR 112-183]. Recommended times were fulfilled in a minority of patients (M2B<90min: 9%,<120min: 34%). Median cathlab D2B was 51min [IQR 44-65], and was less than 45min in 34% of patients. No differences for times to reperfusion within cathlab were found between in- and off-time hours. M2B and D2B were unavailable in 23 patients (26%), because of a spontaneous TIMI 3 flow reperfusion without indication for immediate PCI in 20 patients, contra-indication for PCI in two (distal occlusion, culprit vessel diameter less than 2mm), and failure in occlusion crossing by the guide-wire in one patient. In contrast, first medical contact- or door-to-reperfusion times, assessed by a TIMI 3 flow without no-reflow in culprit artery, were available in 95% of patients, and were shorter than M2B or D2B, respectively.
Although it is a feasible and reproducible process performance measure, D2B time is weakly associated with the outcome of the interventional reperfusion strategy in acute STEMI. This measure should be associated with an outcome performance measure, such as the rate of TIMI 3 flow achieved by primary PCI, or replaced by the Door-to-TIMI 3 flow reperfusion time.
在急性ST段抬高型心肌梗死（STEMI）患者中，近期临床指南建议，应在首次医疗接触后90分钟内或在导管室入院后45分钟内进行直接经皮冠状动脉介入治疗（PCI）。门球时间（D2B）被广泛用于衡量介入中心的工作效率。
分析一系列接受直接PCI的STEMI患者的再灌注时间，并评估D2B在直接PCI中的临床准确性。
2007年1月至2008年3月，我院177例STEMI患者在发病12小时内入院，其中87例接受直接冠状动脉造影以进行直接PCI（47例由移动医疗急救单元转运，40例由我院急诊科转运）。
从首次医疗接触到球囊扩张的中位时间（M2B）为135分钟[四分位间距112 - 183]。少数患者达到了推荐时间（M2B<90分钟：9%，<120分钟：34%）。导管室D2B中位时间为51分钟[四分位间距44 - 65]，34%的患者D2B小于45分钟。导管室内再灌注时间在上班时间和非上班时间之间未发现差异。23例患者（26%）无法获得M2B和D2B，原因是20例患者自发出现TIMI 3级血流再灌注，无需立即进行PCI，2例患者存在PCI禁忌证（远端闭塞、罪犯血管直径小于2mm），1例患者导丝未能通过闭塞病变。相比之下，95%的患者可获得通过罪犯动脉无复流的TIMI 3级血流评估的首次医疗接触至再灌注时间或门至再灌注时间，且分别短于M2B或D2B。
尽管D2B时间是一种可行且可重复的过程性能指标，但它与急性STEMI介入再灌注策略的结果相关性较弱。该指标应与结果性能指标相关联，如直接PCI实现TIMI 3级血流的比率，或由门至TIMI 3级血流再灌注时间取代。
