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Updated: Jul 4, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Achieving rapid reperfusion with primary percutaneous coronary intervention remains a challenge: insights from
Rajendra H Mehta1, Vincent J Bufalino, Wenqin Pan
1Duke Clinical Research Institute and Duke University Medical Center, Durham, NC, USA.
Insights
Door-to-balloon times for ST-elevation myocardial infarction patients improved but remain suboptimal. Delays persist for elderly, women, and minority patients, highlighting the need for quality improvement initiatives.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
- Public Health
Background:
- Door-to-balloon (D2B) time is a critical metric for ST-elevation myocardial infarction (STEMI) reperfusion therapy.
- The target D2B time is ideally less than or equal to 90 minutes.
- Consistency of achieving D2B goals in real-world practice, especially for vulnerable populations, is not well understood.
Purpose of the Study:
- To evaluate the trends and disparities in D2B times for STEMI patients undergoing primary percutaneous coronary intervention (PCI).
- To assess D2B time performance across different patient demographics, including age, sex, and race/ethnicity.
- To identify persistent gaps in care and inform quality improvement efforts.
Main Methods:
- Utilized the American Heart Association Get With the Guidelines database (2002-2006) including 254 US sites.
- Analyzed median D2B times and the percentage of patients achieving D2B ≤90 minutes.
- Employed generalized estimating equations to assess trends over time and disparities among patient subgroups (elderly, women, minorities).
Main Results:
- A total of 10,965 STEMI patients receiving primary PCI were analyzed.
- Overall median D2B time was 96 minutes, with only 44.8% of patients meeting the ≤90 minute goal.
- While D2B times improved significantly over the study period (from 108 to 82 minutes), elderly patients, women, and minorities consistently experienced longer D2B times, with these disparities persisting.
Conclusions:
- Median D2B times for STEMI patients have modestly improved but remain below the recommended 90-minute goal.
- Significant and persistent delays in D2B times were observed in elderly, female, and minority patient populations.
- Continued national quality improvement initiatives are essential to address these disparities and optimize STEMI care.
Background:
The speed of reperfusion (door-to-balloon [D2B] time) is a well established performance metric for patients with ST-elevation myocardial infarction. Although preferably D2B times should be
Methods:
We used the American Heart Association Get With the Guidelines database to study D2B times at 254 participating United States sites (2002-2006). Median D2B time and percentage of compliance with goal (percutaneous coronary interventions [PCI]
Results:
Over the study period, 10965 patients with ST-elevation myocardial infarction who met eligibility criteria received primary PCI (36% aged >or=65 years, 27% female, and 17% nonwhite). The overall median D2B time was 96 minutes (interquartile range [IQR] 69-140 minutes). Only 44.8% of cases had D2B
Conclusion:
The median D2B times with primary PCI have improved modestly in hospitals participating in the American Heart Association Get With the Guidelines program over the last few years but remain below ideal levels. The D2B times are particularly delayed in the elderly people, women, and minority populations; an issue that has persisted over time. These results highlight the ongoing need for national myocardial infarction quality improvement initiatives.
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