title: Treatment delay in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a key process analysis of patient and program factors.
abstract: BACKGROUND
  Most hospitals that perform primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in the United States exceed the recommended door-to-balloon time. There is heightened interest in identifying and eliminating factors that introduce delay.
  
  
  METHODS
  We performed a key process analysis of our primary PCI program, assessed the relative contribution of individual time intervals on total ischemic time, and identified predictors of delay.
  
  
  RESULTS
  Median times and predictors of delay within each time interval were determined for the entire STEMI cohort ("real world") and after exclusion of patients with atypical symptoms and/or presentations of STEMI that resulted in inherent delay in diagnosis and treatment ("ideal world"). Delays in therapy were symptom onset to presentation (120 minutes [interquartile range, IQR, 60-310 minutes, ideal world] and 150 minutes [IQR 60-360 minutes, real world]; predictors of delay were peripheral vascular disease, self-transportation, daytime and weekend presentation); door-to-balloon time (118.5 minutes [IQR 96-141 minutes, ideal world] and 125 minutes [IQR 100-170 minutes, real world]; predictors of delay were female sex, previous stroke, nighttime and weekend presentation, and cardiogenic shock); and symptom onset to first balloon inflation (272 minutes [IQR 187-465 minutes, ideal world] and 297 minutes [IQR 198-560 minutes, real world]; predictors of delay were peripheral vascular disease, weekend presentation, and self-transportation).
  
  
  CONCLUSIONS
  Key process analysis of a primary PCI program identifies treatment delays unique to the hospital and the patient population it serves.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Shailja V
authors.initials: SV
authors.lastname: Parikh
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Jacobi
authors.forename: Edwin
authors.initials: E
authors.lastname: Chu
authors.forename: Tayo A
authors.initials: TA
authors.lastname: Addo
authors.forename: John J
authors.initials: JJ
authors.lastname: Warner
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Delaney
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.forename: James A
authors.initials: JA
authors.lastname: deLemos
authors.forename: Joaquin E
authors.initials: JE
authors.lastname: Cigarroa
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Murphy
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Keeley
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D013997:Time Factors; D016896:Treatment Outcome