Culprit Vessel Revascularization Prior to Diagnostic Angiography as a Strategy to Reduce Delays in Primary Percutaneous Coronary Intervention

Delays are important markers of quality of care in primary percutaneous coronary intervention (PPCI). Door-to-balloon time has been related to mortality, and its relation seems to be strongest in the early hours of symptom onset. In this regards, recent American College of Cardiology/American Heart Association guidelines determine door-to-balloon time goal of <90 minutes for at least 75% of patients admitted initially to a hospital with PPCI capacity and <120 minutes for at least 90% of transferred patients. Many strategies have been successfully applied to shorten door-to-balloon time before catheterization laboratory arrival but few have been studied to reduce delays inherent to the procedure. Hereof, there is scarce data on the impact of obtaining a complete diagnostic angiography before PPCI. Our study sought to determine whether a strategy of performing culprit-vessel revascularization before obtaining contralateral or complete diagnostic angiography could be associated with a reduction in delays and outcomes in ST-segment–elevation myocardial infarction (STEMI) patients.