Modifiable factors associated with prolonged door to balloon time in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Door to balloon (D2B) time was reported an important factor of the clinical outcome of patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). D2B time is influenced by various factors; however, modifiable factors have not been adequately evaluated. The purpose of this study was to identify modifiable factors associated with prolonged D2B time. We historically included 239 consecutive STEMI patients who visited emergency department and underwent primary PCI between April 2013 and September 2016. We evaluated baseline characteristics, mode and timing of hospital arrival, symptoms and signs, treatment times and angiographic characteristics. Patients with D2B time>90min were compared with those with D2B time90min. Modifiable factors associated with prolonged D2B time (>90min) were analyzed by multivariable logistic regression model. The median D2B time for the entire cohort was 69min (interquartile range 54-89) and 24% had a D2B time of>90min. Modifiable factors associated with prolonged treatment time (D2B time>90min) were electrocardiogram (ECG) to puncture time>50min [odds ratios (OR) 96.0, 95% confidence intervals (95% CI) 25.1-652.5, P<0.0001), door to ECG time>10min (OR 49.8, 95% CI 11.8-357.5, P<0.0001), and puncture to balloon time>30min (OR 48.5, 95% CI 12.0-333.8, P<0.0001). ECG to puncture time>50min was the most important modifiable factor associated with prolonged D2B time in STEMI patients.