Time to treatment-door-to-balloon time is not everything

Area of Science:

• Cardiology
• Healthcare Quality Improvement
• Health Systems Research

Background:

• International guidelines recommend performance measures to assess STEMI care quality.
• Door-to-balloon (D2B) time and system delay are key metrics for primary percutaneous coronary intervention (PPCI).
• Current definitions lack clarity, leading to confusion in reperfusion strategy assessment.

Purpose of the Study:

• To call for consensus on objective performance measures for STEMI management.
• To clarify definitions of D2B time and system delay.
• To demonstrate the inadequacy of focusing solely on D2B time.

Main Methods:

• Literature review and critical analysis of existing performance measures for STEMI.
• Examination of definitions for D2B time and system delay.
• Discussion of the implications for reperfusion strategy.

Main Results:

• Significant confusion exists regarding the precise definitions of D2B time and system delay.
• System delay and PCI-related delay are frequently used interchangeably, exacerbating definitional ambiguity.
• Focusing exclusively on D2B time is insufficient for comprehensive quality assessment.

Conclusions:

• There is a critical need for standardized, objective performance measures in STEMI care.
• Clearer definitions of D2B time and system delay are essential for accurate quality monitoring.
• A consensus on performance measure definitions will improve STEMI system of care evaluation and patient outcomes.