title: Door to balloon and door to needle: temporal trends in delays to reperfusion.
abstract: BACKGROUND
  Reperfusion practices have changed markedly over the last few years with the introduction of primary percutaneous coronary intervention. This technique has gained growing popularity in Israel, but little published data are available regarding the delays to primary PCI in real life in this country.
  
  
  OBJECTIVE
  To examine temporal trends in time to reperfusion achieved in a large tertiary center over 6 years.
  
  
  RESULTS
  Between 1997 and 2002, 1,031 patients were admitted to our hospital with ST elevation myocardial infarction. Of these, 62% underwent thrombolysis and 38% primary PCI. The proportion of patients referred for primary PCI increased steadily, from 14% in 1997 to 68% in 2002. Door to treatment time among patients referred for thrombolysis or primary PCI was 54 +/- 42 and 117 +/- 77 minutes, respectively (P < 0.00001). The door to needle time in patients given thrombolysis remained virtually unchanged during the study period at around 54 minutes. In contrast, the door to balloon time progressively and substantially decreased, from 175 +/- 164 minutes in 1997 to 96 +/- 52 minutes in 2002.
  
  
  CONCLUSIONS
  There is a steady increase in the proportion of patients referred for primary PCI than for thrombolysis. The door to needle delay in patients given thrombolysis substantially exceeds the recommended time. The door to balloon time has declined considerably but still slightly exceeds the recommended time. Given the inherent delay between initiation of lysis and arterial recanalization, it appears from our experience that PCI does not substantially delay arterial reperfusion as compared to thrombolysis. Efforts should continue to minimize delays to reperfusion therapy.
authors.affiliation: Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Arik
authors.initials: A
authors.lastname: Wolak
authors.forename: Harel
authors.initials: H
authors.lastname: Gilutz
authors.forename: Guy
authors.initials: G
authors.lastname: Amit
authors.forename: Carlos
authors.initials: C
authors.lastname: Cafri
authors.forename: Reuben
authors.initials: R
authors.lastname: Ilia
authors.forename: Doron
authors.initials: D
authors.lastname: Zahger
mesh_terms: D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors