Prolonged D2B Time is Associated with Diastolic Dysfunction in STEMI Patients Undergoing Primary PCI

Yu-An Chen,  Kuan-Cheng Chang

Abstract (2011.06)

 

Background and Purpose

Primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) significantly reduces mortality and morbidity, particularly when the door-to-balloon (D2B) time is shortened to < 90 minutes. We sought to investigate whether D2B time correlates with in-hospital left ventricular (LV) function.

  

Materials and Methods

A total of 340 consecutive STEMI patients who received primary PCI were divided into two groups by patient aged ≥ 65 years old and < 65 years old. Conventional echocardiography and tissue Doppler imaging at the septal mitral annulus were performed during hospitalization. The ratio of early mitral inflow E to early diastolic velocity e’ greater than 15 was defined as LV diastolic dysfunction. LV systolic dysfunction was defined as LV ejection fraction < 50%.

  

Results

Risk factors significantly associated with LV diastolic dysfunction included age ≥ 65 years, female gender, hypertension, higher Killip (III+IV) status, and D2B time ≥ 90 minutes. Further analysis revealed that the adverse impact of prolonged D2B time on LV diastolic function was more prominent in patients aged ≥ 65 years than in the younger group.

  

Conclusions

Prolonged D2B time ≥ 90 minutes in acute STEMI patients undergoing primary PCI is associated with impaired LV diastolic function. Consequently, cardiologists should collaborate with the emergency physicians to improve D2B times, particularly for older patients.

  

Key words

Diastolic function; primary percutaneous coronary intervention; door-to-balloon times