Door-to-balloon: Where do we lose time? Single centre experience in India

Background/AimsTo assess the factors causing delay in attaining DTB time of <90 min.MethodsEighty-five patients who underwent primary PCI from August 2008 to July 2009 were studied. From door-to-balloon, time was divided into 6 stages; any reason for delay was studied.ResultsThe mean DTB time was 80.5 min (SD = 34.4, median time 75 min, range 30-195). DTB time was <90 min in 76.5%, and DTB time >90 min occurred in 23.5%. Mean door to ECG - 6.5 min (SD = 2.7), mean time for the decision of PCI - 7.5 min (SD = 10.5), mean time taken for the patient's consent - 19.6 min (SD = 17.6), for STEMI team activation - 6.7 min (SD = 7.6), average time for financial process - 39.2 min (SD = 22.9). Average time for sheath to balloon - 5.2 min (SD = 1.7). Hospital related delay occurred in 5%, patient related delay in 80%, both together in 15%. 89.5% of patient related delay was due to delay in giving consent and financial reasons. There was no statistically significant delay for patients presented at morning or night and during the weekdays or weekend. Total mortality was 4.7%. Mortality among <90 min was 3.1%, mortality among >90 min was 10% ('p' = 0.2).ConclusionsWith effective hospital strategies, the DTB time of 90 min can be achieved in majority of patients. The chief delay in DTB time in this study was due to a delay in obtaining consent and financial reasons.