Delay in Door-to-door-to-balloon time for Primary PCI is rarely Related to Cardiologists Late Arrival

IntroductionInterventional cardiologists are held accountable for delay in the door-to-balloon time (DBT) for patients undergoing primary percutaneous coronary intervention in the setting of ST-elevation myocardial infarction (STEMI) even though in the chain of STEMI activation, the interventional cardiologist is the last person that needs to be available to start angiography. The goal of our study is to conduct a thorough analysis of the DBT data to assess time delays by randomly evaluating two consecutive years at the University of Arizona Medical Center (UAMC). METHODSWe evaluated all available DBT data for STEMIs occurring in the fiscal years of 2011 and 2012 at the UAMC and calculated the time needed for the cardiologist to start the procedure after the patient was ready in the cardiac catheterization laboratory called Time to start the procedure (TSP) in addition to other time intervals. RESULTSMean TSP time was 4 minutes and 24 seconds, one of the shortest time delays in the chain of STEMI activation and DBT. The median TSP delay was 3 minutes. The longest delay interval was the STEMI teams arrival to with a mean of 17 minutes and 38 seconds. CONCLUSIONSOur data is the first to evaluate delays related to DBT revealing the least delay occurring due to the late arrival of Interventional cardiologists. Our data emphasizes the importance of performing a detailed time analysis of the DBT delay in order to objectively determine the actual areas of delay and provide a future pathway to improve them since we have specifically detected a delay in STEMI team and patient arrival to the catheterization laboratory as the main delay in the DBT time. in order to avoid blaming the wrong person and find the true root cause of the delay.