Study Questions Shorter Pain-to-Balloon Time Paradigm

In transferred patients, a shorter pain-to-balloon time does not decrease the extent of infarct size

WEDNESDAY, July 11 (HealthDay News) -- In patients transferred for primary percutaneous coronary intervention, a shorter pain-to-balloon time is not associated with a decrease in infarct size, and such patients may in fact have a larger infarct, according to a study published in the July issue of the American Journal of Cardiology. This may be because such patients have the most severe symptoms and already have a larger infarct due to unavoidable delays in treatment, the authors suggest.

Giovanni Donato Aquaro, M.D., of Pisa University in Pisa, Italy, and colleagues studied 60 patients (mean age 64) who were treated within one of three time periods: 168 minutes, 169 to 300 minutes, and longer than 300 minutes. They used a presentation score system to classify severity of presentation at admission and performed magnetic resonance imaging a mean of six days after percutaneous coronary intervention.

The researchers found that those treated within 168 minutes had a higher presentation score, including more severe electrocardiographic alterations, higher levels of serum markers of myocardial necrosis, and greater regional ventricular dysfunction on first echocardiogram. They also found that those with the shortest pain-to-balloon time had infarcts larger than the intermediate group (169 to 300 minutes) and no different from those treated after 300 minutes.

"We found that patients with worse presentation are transferred sooner for primary percutaneous coronary intervention," the authors conclude. "This approach in these patients does not decrease infarct size likely because of unavoidable delay to reperfusion. This finding suggests a different therapeutic strategy in these patients."

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