title: Quality measure study: progress in reducing the door-to-balloon time in patients with ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Reperfusion therapy improves both mortality and morbidity in patients with ST-elevation myocardial infarction (STEMI). Timeliness of such reperfusion is an important factor in improving patient survival. For percutaneous coronary intervention (PCI), the American College of Cardiology has recommended a goal of <90 minutes from initial hospital contact to first balloon inflation.
  
  
  METHODS
  The authors retrospectively reviewed 131 patients with a diagnosis of STEMI seen at a PCI capable hospital between January, 2006 and September, 2008, a period of time before and after implementation of a protocol aimed at reducing door-to-balloon time. Sixty-one percent of study population was Asian or Pacific Islander. This protocol was largely based on the identification by Bradley et al. of factors whose modification could shorten this time interval.
  
  
  RESULTS
  Time to reperfusion was compared between groups before (n=57), and after (n=58) protocol implementation. Median door-to-balloon time for the former group was 133 minutes, interquartile range (IQRs), (25th, 75th percentile; 104.5, 147), and for the latter group 67 minutes, IQRs (56, 80) respectively (p<0.001). Prior to implementation of the protocol, a door-to-balloon time of <90 minutes was achieved in 17% of cases. By the third quarter of 2008, this goal was being met in 100%.
  
  
  CONCLUSIONS
  This observational study provides support for the use of the strategies described as a key for reduction in door-to-balloon time.
authors.affiliation: John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96813, USA.
authors.forename: Katsufumi
authors.initials: K
authors.lastname: Nishida
authors.forename: Sean K
authors.initials: SK
authors.lastname: Hirota
authors.forename: Todd B
authors.initials: TB
authors.lastname: Seto
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Smith
authors.forename: Cathy
authors.initials: C
authors.lastname: Young
authors.forename: Wanda
authors.initials: W
authors.lastname: Muranaka
authors.forename: Suzanne
authors.initials: S
authors.lastname: Beauvallet
authors.forename: David
authors.initials: D
authors.lastname: Fergusson
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000592:standards*; D004562:Electrocardiography; D005260:Female; D006254:Hawaii; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013997:Time Factors