D2B Times Need to be 'As Soon as Possible'
It's been said that the 90-minute threshold for door-to-balloon (D2B) times was an arbitrary choice, albeit a good one to help focus international attention on improving survival among sudden cardiac arrest patients. It's likely the threshold will be lowered in time. Researchers in a British Medical Journal study, however, suggest the standard should be "as soon as possible" for patients undergoing PCI. Researchers studied records from the American College of Cardiology's National Cardiovascular Data Registry and found a linear relationship between increased D2B times and increased rate of death.

Results from the BARI 2D trial found that PCI was favored over CABG for diabetics with multivessel disease (56 percent vs. 44 percent). The study took place between 2001 and 2005. The utilization of drug-eluting stents (DES) has significantly risen since then and may by on the rise in this patient population, especially since the SYNTAX trial found that diabetics should not be grouped together as all having "complex" disease. With this understanding, physicians can evaluate diabetics on their own terms, possibly using the SYNTAX score, and have the option to choose PCI over CABG.

Finally, it bears mentioning that the FDA has approved the Taxus Liberte Atom Stent for treating vessels as small as 2.25 mm in diameter. The Liberte joins the Taxus Atom as the only two DES approved for treating small vessels. The Liberte, however, features design and deliverability improvements over the Atom, such a thinner struts and uniform stent geometry for consistent lesion coverage and drug distribution.

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Chris Kaiser, Editor