Culprit vessel PCI versus traditional cath and PCI for STEMI.

OBJECTIVE: To compare door-to-balloon times with culprit vessel percutaneous coronary intervention (PCI) as initial treatment for ST-elevation myocardial infarction (STEMI) to traditional complete coronary angiography followed by PCI for treatment of STEMI. BACKGROUND: Shorter door-to-balloon time for STEMI treatment is associated with better outcomes, and is generally achieved by shortening the door-to-vascular access time. Whether procedural improvements can shorten the vascular access-to-balloon time has not been examined. METHODS: Door-to-balloon times were assessed in 50 consecutive patients who underwent initial PCI of the culprit vessel for STEMI at Wake Forest University Baptist Medical Center, and in 85 consecutive patients who underwent traditional coronary angiography followed by PCI for STEMI. RESULTS: Procedural success was 100% in both groups. Door-to-balloon times were 66 +/- 20 minutes for culprit PCI vs. 79 +/- 28 minutes for traditional PCI, p < 0.001, due to shorter vascular access-to-balloon time, 11 +/- 8 minutes for culprit PCI vs. 18 +/- 8 minutes for traditional PCI, p < 0.001. 92% of the culprit PCI group had a door-to-balloon time < 90 minutes, compared to 76% in the traditional group, p = 0.023. Subsequent planned revascularization procedures were infrequent and similar in both groups. CONCLUSIONS: In this small pilot study, performing PCI of the culprit vessel for STEMI as initial treatment resulted in a decrease in the door-to-balloon time compared to traditional coronary angiography followed by PCI without compromising subsequent cardiac care. Whether broader utilization of this strategy will result in beneficial outcomes remains to be determined.