Optimizing Door-to-Balloon Time in Primary Percutaneous Coronary Intervention

Recommendations for Door-to-Balloon Time

The American College of Cardiology and American Heart Association recommend a door-to-balloon time ≤90 minutes for patients presenting directly to PCI-capable hospitals 1, 2, 3, 4, 5
The American College of Cardiology and American Heart Association recommend a first medical contact-to-balloon time ≤120 minutes for patients transferred from non-PCI capable hospitals 6, 4
For STEMI patients, the American College of Cardiology and American Heart Association recommend a door-to-needle time within 30 minutes and a door-to-balloon time within 90 minutes to optimize patient survival and reduce morbidity 3, 4, 5
The target door-to-needle time is ≤30 minutes from hospital arrival to fibrinolytic administration, applying to patients transported to non-PCI capable hospitals where fibrinolysis is the chosen reperfusion strategy 3, 4, 5
For EMS systems with fibrinolytic capability, treatment should begin within 30 minutes of EMS arrival on scene, according to the American College of Cardiology 4

The guidelines specify a balloon inflation goal within 90 ± 30 minutes of hospital admission 1
The target door-to-balloon time is ≤90 minutes from hospital arrival to balloon inflation, applying to patients transported directly to PCI-capable hospitals 3, 4, 5
For patients transferred from non-PCI capable hospitals to PCI-capable facilities, the goal is to achieve balloon inflation within 90 minutes of first medical contact, as recommended by the American College of Cardiology 4

Rapid reperfusion through primary PCI has been consistently shown to improve outcomes, including lower rates of recurrent ischemia, reinfarction, emergency repeat revascularization procedures, intracranial hemorrhage, and death 6

Rapid triage protocols with 12-lead ECG acquisition and interpretation within 10 minutes of ED arrival are recommended to achieve time targets 3
Direct activation of the cardiac catheterization laboratory without requiring cardiology consultation is advised, as consultation delays therapy and increases mortality, according to the American Heart Association 5
Implementing pre-hospital ECG transmission can expedite STEMI diagnosis and improve outcomes 5
Successful programs address delays through standardized chest pain protocols, immediate ECG for all potential STEMI patients, single-call activation systems for the catheterization laboratory, catheterization laboratory staff arrival within 20-30 minutes of activation, and real-time performance feedback within 24-48 hours

Several factors commonly contribute to delays in achieving target door-to-balloon times, including late identification of patients with chest pain, delays in obtaining ECGs, delays in catheterization laboratory activation, and transportation delays