A campaign to improve the timeliness of primary percutaneous coronary intervention - Door-to-balloon: An alliance for quality

In 1971, Eugene Braunwald, MD, MACC, postulated a revolutionary hypothesis: Time is muscle. He proposed that acute myocardial infarction is a dynamic process and that the severity and extent of myocardial ischemic injury resulting from coronary occlusion could be radically altered by an appropriate intervention "as late as 3 hours after the coronary occlusion." Subsequent clinical trials confirmed that restoration of coronary patency improves survival but, to be maximally beneficial, revascularization must be induced within a time window much narrower than Dr. Braunwald proposed. For example, Brodie and colleagues evaluated 2,322 consecutive patients treated with primary PCI and followed them for a median of 83 months. Evaluating outcomes by door-to-balloon (D2B) times showed a stepwise increase in both in-hospital and long-term mortality for increasing D2B times (Slide 1). Those at highest risk benefited the most from short D2B times, especially when they presented within 3 hours of symptom onset.