“Door-In to Door-Out” Delay in Patients with Acute ST-Segment Elevation Myocardial Infarction Transferred for Primary Percutaneous Coronary Intervention in a Metropolitan STEMI Network of a Developing Country

Abstract

Routine performance measures of primary percutaneous coronary intervention (PCI) within an ST-segment elevation myocardial infarction (STEMI) network are needed to improve care.We evaluated the door-in to door-out (DI–DO) delays at the initial hospitals in STEMI patients as a routine performance measure of the metropolitan STEMI network.We retrospectively analyzed the DI–DO time from 1,076 patients with acute STEMI who were transferred by ground ambulance to a primary PCI center for primary PCI between 4 October 2014 and 1 April 2019. Correlation analysis between DI–DO times and total ischemia time was performed using Spearman's test. Logistic regression analyses were used to find variables associated with a longer DI–DO time.Median DI–DO time was 180 minutes (25th percentile to 75th percentile: 120–252 minutes). DI–DO time showed a positive correlation with total ischemia time (r = 0.4, p < 0.001). The median door-to-device time at the PCI center was 70 minutes (25th percentile to 75th percentile: 58–88 minutes). Multivariate analysis showed that women patients were independently associated with DI–DO time > 120 minutes (odds ratio 1.55, 95% confidence interval 1.03 to 2.33, p = 0.03).The DI–DO time reported in this study has not reached the guideline recommendation. To improve the overall performance of primary PCI in the region, interventions aimed at improving the DI–DO time at the initial hospitals and specific threat for women patients with STEMI are possibly the best efforts in improving the total ischemia time.

Acute coronary syndrome treatment delay in low to middle-income countries: A systematic review

“…Similarly, a history of chronic angina was higher in women 64% than the 50% observed in men [37] . Women also had a lower probability of receiving proper treatment for STEMI than men in several studies [26] , [38] .…”

“…In the current study, the duration of time from symptom onset to first medical contact ranged from less than 10 min [14] to 96 h [15] with a mean of 12.7 h. In three studies, the focus was the delay between arrival to the emergency department and treatment initiation [16] perceptions of treatment urgency for ACS symptoms [17] and the overall time delay to treatment [18] . Four studies reported that all patients sought medical contact within 12 h of symptom onset [19] , [20] , [21] , [22] , while 26 studies reported treatment delays of 12 h or more, of these, 7 studies showed that at least 50% of the study population were delayed for 12 h until the initial medical contact [15] , [23] , [24] , [25] , [26] , [27] , [28] . Only 1 study by Sharma and colleagues [29] targeted characteristics of patients arriving over 12-hours from symptom onset to treatment.…”

“…In a retrospective study of 1076 STEMI patients in Indonesia using the Jakarta Acute Coronary Registry, the median time from symptom onset to treatment was 180 min; only 63 (6.4%) patients arrived within 60-minutes of symptom onset with the majority presenting after 180 min [26] . Notably, the door to PCI time was 70 min, and within the guideline-recommenced time frame of 90-minutes [11] , [12] .…”

“…Patients who were carried by an ambulance or seen directly in hospital emergency initially had significantly shorter delay time than those who visited a private doctor. * * * Poor Dakota, et al, 2020 [26] Retrospective, cross-sectional. Jakarta, Indonesia registry database 1076 Median age was 55 (range 48–61).…”

Cardiac mortality benefit of direct admission to percutaneous coronary intervention–capable hospital in acute myocardial infarction

“…Although we were unable to define door-in-door-out (DIDO) time, it might have influenced SAT in the region with a short driving time. [ 14 , 24 ] Second, the optimal goal of SBT of STEMI might require a stricter value. The stratification of SBT <120, <180, and <360 minutes and setting a goal could strongly impact survival in patients with AMI.…”