Shorter Door-To-Balloon ST-Elevation Myocardial Infarction Time: Should There Be a Minimum Limit?

In ST-elevation myocardial infarction (STEMI) ischemic time is directly related to permanent myocardial damage and mortality. Therefore, it is crucial to restore myocardial perfusion rapidly. Door-to-balloon (DTB) time is defined as the duration between the arrival time of the patient to the medical facility until the time he or she is treated with percutaneous coronary intervention. Currently, DTB is the criterion that measures the quality of care provided to patients with STEMI at any given institution. It is well documented in the literature that longer DTB is associated with higher mortality; however, lowering DTB beyond current recommendations has not shown to decrease mortality rates. The current recommendations call for a DTB less than 90 minutes from the patient's first contact within the healthcare system, typically the arrival to the emergency department, to the time of the balloon inflation of the culprit coronary artery. Conversely, efforts to keep reducing DTB time may lead to unnecessary percutaneous coronary intervention (in false-positive STEMI) and delay appropriate therapy when needed, possibly missing an alternate potentially life-threatening diagnosis. In conclusion, we herein review the literature on DTB and mortality rate. We also make suggestions about ideal DTB time and hazards of shortening it beyond the recommended guidelines.