Time is muscle in primary PCI: the strength of the evidence grows

This editorial refers to “Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty”1 by G. De Luca et al. on page 1009 In this issue of the European Heart Journal, De Luca et al. , demonstrate that among 1072 patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI), prolonged times between symptom onset and the first balloon inflation are associated with impaired ST-segment resolution, impaired myocardial blush grades, larger infarct sizes and higher mortality. 1 These data add to a growing body of literature suggesting that renewed efforts are needed to reduce symptom-to-door and door-to-balloon times in order to improve myocardial perfusion, myocardial salvage and clinical outcomes among patients undergoing primary PCI for STEMI. 1 While an association between prolonged door-to-balloon times and mortality has been described previously, the association of symptom-to-door and symptom-to-balloon times has not been as well established in its association with mortality. 2 The demonstration of such an association may be hampered by survival bias: those patients with prolonged symptom-to-door times may not survive to be included in analyses such as the present one. 2 It is noteworthy therefore that despite being enriched … *Correspondence to: C. Michael Gibson, M. S. , M. D. , 350 Longwood Avenue, First Floor, Boston MA, USA. Tel.: +1-617525-6884; fax: +1-888-249-5261 E-mail address: mgibsonattimi. org