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Door-to-balloon time and factors associated with delayed door-to-balloon time in ST-segment elevation myocardial
Wiwun Tungsubutra1, Deachart Ngoenjan1
1Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Delayed door-to-balloon (DTB) times, crucial for ST-segment elevation myocardial infarction (STEMI) care, affected 70.7% of patients. Key delays stemmed from mistriage to urgent care and presentation during on-call hours.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
- Emergency Medicine
Background:
- Door-to-balloon (DTB) time is a critical performance metric in ST-segment elevation myocardial infarction (STEMI) management.
- Timely reperfusion therapy significantly impacts patient outcomes in STEMI.
Purpose of the Study:
- To analyze DTB times in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
- To identify clinical factors associated with delayed DTB at a major tertiary referral center in Thailand.
Main Methods:
- An observational study analyzed DTB times for STEMI patients from June 2008 to May 2011.
- A DTB time exceeding 90 minutes was defined as delayed.
- Clinical variables were collected to assess associations with DTB delays.
Main Results:
- 70.7% of 133 STEMI patients experienced delayed DTB.
- Median DTB time was 117 minutes overall.
- Mistriage to urgent care and presentation during on-call hours were significantly associated with delays (P < 0.001).
- Presentation during on-call hours was the sole significant predictor of delayed DTB in multivariate analysis (OR, 7.86).
Conclusions:
- Delayed DTB is prevalent in STEMI patients, with 70.7% experiencing delays.
- Patient mistriage to urgent care and presentation during on-call hours are significant contributors to delayed reperfusion therapy.
- Addressing these factors may improve DTB times and patient outcomes in STEMI care.
Objective:
To analyse door-to-balloon (DTB) time and to identify factors significantly associated with delayed DTB in patients with ST-segment elevation myocardial infarction (STEMI) at Thailand's largest tertiary referral centre.
Background:
DTB time is considered an important measure of performance quality.
Methods:
This observational study analysed DTB time in patients with STEMI who presented to our institute's emergency department and underwent primary percutaneous coronary intervention (PCI) during June 2008 to May 2011. DTB time greater than 90 minutes was considered delayed. Data were collected to determine which clinical variables were associated with delays.
Results:
One hundred thirty-three patients were included. The mean age of patients was 61.1 ± 13.2 years, and 71.4% were male. Delayed DTB was observed in 70.7% of patients. Median DTB time was 117 (interquartile range [IQR], 86-168), 66 (IQR, 58-84), and 135 (IQR, 112-194) minutes in all patients, in nondelayed patients, and in delayed patients, respectively. Univariate analysis revealed triage to urgent care (P = 0.001) and presentation during on-call hours (P < 0.001) to be significantly associated with delayed DTB. Patients who were triaged to urgent care had a DTB time of 184 vs 105 minutes for triage to the emergency room. Patients who presented during on-call hours had a DTB time of 128 vs 86 minutes for work hour presentation. Presentation during on-call hours was the only significant predictor of DTB time >90 minutes in multivariate analysis (odds ratio [OR], 7.86; 95% confidence interval [CI], 3.39-18.22; P < 0.001). All patients that were triaged to urgent care were delayed; thus, association between urgent care triage and on-call hour service could not be determined.
Conclusions:
Delayed DTB time occurred in 70.7% of patients. Two key factors that significantly contributed to delayed DTB were patient mistriage to urgent care and presentation during on-call hours.