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Door-to-activation times drove overall door-to-balloon times
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A door-to-activation time of 20 minutes or less was key to achieving a door-to-balloon time of 90 minutes or less, study results found.
In the study, researchers aimed to assess the roles of three factors: the time from diagnosing STEMI to activating the cath lab (door-to-activation time), the time required for cath lab preparation and patient transport (activation-to-laboratory time), and the time required from arrival in the laboratory to starting the artery-opening procedure (laboratory-to-balloon time). They reviewed data from the Activate-SF registry on 347 consecutive patients diagnosed with a STEMI for 30 months at the EDs of the University of California, San Francisco and San Francisco General Hospital.
Median door-to-activation time was 19 minutes (interquartile range, 9-54). Variation in door-to-activation had the strongest correlation, explaining 93% of the variation in door-to-balloon times (r=0.97). A door-to-activation time of 20 minutes or less had an 89% chance of achieving a door-to-balloon time of 90 minutes or less compared with only 28% for patients with a door-to-activation time longer than 20 minutes.
Other factors significantly associated with door-to-activation time included pre-hospital ECG use (61% shorter; 95% CI, –50 to –72) and CT scans in the ED (245% longer; 95% CI, 50-399).
“In the current era, the catheterization team has limited impact on variations in door-to-balloon times, which are largely determined by the preceding events,” the researchers wrote. “Focusing solely on strategies to reduce door-to-balloon times that are initiated after an STEMI diagnosis is established may fail to address the primary source of delay in timely reperfusion with PCI.”
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