National guidelines say patients undergoing heart attacks should receive balloon angioplasties as soon as possible or within 90 minutes of arriving at the hospital -- known as the "door-to-balloon time."

Now, some hospitals are striving to reduce door-to-balloon times to under 60 minutes.

"Time is Muscle," said Dr. Fred Leya, medical director of Loyola University Hospital's cardiac catheterization lab. "If we can reopen the artery within 30 minutes, there will be essentially no damage. If we do it within 30 to 60 minutes, there will be minimal damage. That's why we call the first 60 minutes the Golden Hour of Opportunity."

A 2009 study in the British Medical Journal documented how a rapid response can save lives. Researchers examined records of 43,801 patients at more than 600 hospitals in the United States. The in-hospital mortality rate was 7 percent among patients with 150-minute door-to-balloon times, 4.3 percent among those treated in 90 minutes and just 3 percent among those treated in 30 minutes.

"Physicians could reduce mortality among such patients by minimizing door-to-balloon times to the greatest extent possible," researchers wrote.

Heart attack patient Michael Tyler illustrates the benefits of a rapid door-to-balloon time. Tyler, a railroad conductor, was preparing to depart from the Union Pacific yard in Northlake, Ill. when he experienced chest pain and shortness of breath. Tyler asked his engineer to call 911. Paramedics administered an EKG and radioed the results ahead to Loyola. As soon as Tyler arrived at the ER around 1 a.m., he was rushed to the cardiac catheterization lab. Loyola has an interventional cardiologist on site 24 hours a day, seven days a week.

Tyler's left anterior descending artery, one of the major coronary arteries, was 100 percent blocked. Working quickly but carefully, an interventional cardiologist threaded a catheter (thin tube) from an artery in Tyler's groin to his heart. The cardiologist inflated a balloon at the tip of the catheter to open the artery, and placed a stent (wire mesh tube) to keep the artery open.

Tyler's heart attack was stopped as soon as the artery was opened. Because blood flow was quickly restored, there was very little damage to his heart muscle. His door-to-balloon time was 33 minutes.

"It was a great example of how rapid treatment can preserve hearts and save lives," Leya said.

Source
Loyola University Health System