Door-to-Balloon Time Guidelines
Core Definition Components
- The American Heart Association (AHA) and American College of Cardiology (ACC) define door-to-balloon time as the interval from patient arrival at the emergency department door to the time of first balloon inflation during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), with a target goal of ≤90 minutes 1, 2
- The AHA/ACC guidelines establish that door-to-balloon time specifically measures the starting point of time of arrival at the emergency department door and the endpoint of time of balloon inflation in the culprit coronary artery during primary PCI 1, 3
- The target goal for door-to-balloon time is ≤90 minutes, which is a systems goal, not an "ideal" time, but rather the longest acceptable time 1, 3, 4
Expanded Time Metrics
- The First Medical Contact-to-Balloon Time is defined as the time from EMS arrival on scene or time of arrival at the emergency department door to balloon inflation, with a 90-minute goal 1, 3, 4
- For patients presenting directly to PCI-capable hospitals, the European Society of Cardiology (ESC) guidelines recommend a door-to-balloon time of <60 minutes 6
- The AHA maintains the 90-minute benchmark but emphasizes achieving faster times when possible 4, 7
Important Distinctions
- Door-to-balloon time differs from other reperfusion metrics, such as door-to-needle time, which measures time from hospital arrival to initiation of fibrinolytic therapy, with a goal of ≤30 minutes 1, 5
- Door-in to door-out (DI-DO) time measures time from arrival to departure for transfer, with a goal of ≤30 minutes 6
Clinical Context and Caveats
- The 90-minute DTB goal is explicitly described as a systems goal rather than an individual patient target, and individual patient delays may occur due to diagnostic uncertainty or anatomical challenges during the procedure 1, 4
- Recent evidence demonstrates that mortality increases continuously with longer DTB times, suggesting an "as-soon-as-possible" standard rather than accepting 90 minutes as adequate 7
- Each 15-minute delay in DTB time is associated with increased mortality risk 8, 9