A systematic review of factors predicting door to balloon time in ST-segment elevation myocardial infarction treated
Michael C Peterson1, Tyler Syndergaard, Josh Bowler
1University of Utah School of Medicine, Salt Lake City, UT, USA. michael.peterson@hsc.utah.edu
Insights
Door to balloon time in ST-elevation myocardial infarction (STEMI) is crucial. This review identifies patient, hospital, and care factors influencing this critical metric for primary percutaneous intervention outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Door to balloon time is a key determinant of outcomes for ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous intervention (PCI).
- Identifying factors that influence this time is essential for optimizing patient care.
- This review synthesizes evidence on prognostic factors affecting door to balloon time in STEMI patients treated with PCI.
Purpose of the Study:
- To systematically review and summarize prognostic factors associated with door to balloon time in STEMI patients.
- To identify modifiable and non-modifiable factors that impact the timeliness of primary PCI.
Main Methods:
- A comprehensive literature search was conducted using NLM Gateway and Cochrane CENTRAL.
- Articles were screened by title and abstract, with full-text retrieval for relevant studies.
- Included articles were assessed for risk of bias, and findings were summarized qualitatively.
Main Results:
- Ninety papers were included, with variable and generally low study quality.
- Factors associated with longer door to balloon times include pre-hospital delay, cerebrovascular disease, absence of chest pain, lower PCI volume, lower ST elevation, absence of Q waves, and left bundle branch block.
- Shorter times were linked to presentation during regular hours, recent PCI year, 24-hour cardiology, pre-hospital ECG, streamlined lab activation, and culprit vessel PCI before full angiography.
Conclusions:
- Understanding the prognostic factors for door to balloon time is vital for enhancing the quality of care for STEMI patients.
- Targeting identified factors can lead to improved treatment efficiency and patient outcomes.
Background:
Door to balloon time is important in the outcome of ST-elevation myocardial infarction treated with primary percutaneous intervention. This review summarizes prognostic factors for door to balloon time in STEMI patients presenting to a PCI capable hospital.
Method:
NLM Gateway and Cochrane CENTRAL are the primary data sources. Searched reports were screened by title and abstract and full texts were located for potentially relevant articles. References from the selected articles and relevant background papers were hand searched for additional reports. Articles were reviewed and assessed for risk of bias. The results are summarized without meta-analysis.
Results:
90 papers are included in the review. Individual study quality was variable but was generally low. A number of patient characteristics, hospital characteristics, physician characteristics, care processes and "other" factors were associated with door to balloon time. Prognostic factors for longer times include: pre-hospital delay in presentation, cerebrovascular disease, absence of chest pain, lower PCI volume and specialization hospital, lower sum ST elevation, absence of Q waves and left bundle branch block. Shorter times were associated with: presentation during regular hours, PCI in a more recent year, 24 hour on site cardiology, pre-hospital ECG, single call to central page to activate the catheterization lab, ER physician activating the cath lab, lab staff arriving within 20 min of paging and culprit vessel PCI before full diagnostic angiography.
Conclusion:
Understanding prognostic factors for door to balloon time can likely lead to improved quality of care for STEMI.
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