An analysis of door-to-balloon time in a single center to determine causes of delay and possibilities for improvement

Objectives: We analyzed door-to-balloon times in our institution to identify those factors which significantly prolong time to treatment in ST elevation myocardial infarction (STEMI). Background: Recent data have shown that patients with myocardial infarction transferred from one institution to another for PCI and those presenting outside of normal working hours suffer considerably prolonged door-to-balloon times. Methods: We analyzed the door-to-balloon time and its components from January 2005 to March 2006 in 167 consecutive patients presenting with STEMI to determine which variables were associated with delays. Results: The median door to balloon (DTB) time of all patients was 127 min. DTB was 62 min (P = 0.001) for patients presenting directly during working hours, 111.5 min for patients presenting directly during on-call hours, 157.5 min for patients presenting to outside hospitals during working hours and 149 min for patients transferred from outside hospitals during on-call hours. Factors that significantly lengthened DTB time included presentation during on-call hours (P = 0.007), outside hospital presentation (<0.001), prolonged time from chest pain onset to presentation (P = 0.004), absence of chest pain on presentation (P = 0.01), and cardiac arrest before PCI (P = 0.05). Conclusion: In our center, transport time and on-call hour delays account for the majority of reperfusion delay. Other factors that influenced delay were atypical presentation without chest pain, borderline ST changes, or delayed presentation. Thus, transfer from an outside facility, presentation after working hours, and having a difficult diagnosis all influence the rapidity of treatment. The implementation of an in-house STEMI response team may reduce the process induced delays and improve door-to-balloon times. (C) 2008 Wiley-Liss, Inc.