title: A systematic review of factors predicting door to balloon time in ST-segment elevation myocardial infarction treated with percutaneous intervention.
abstract: BACKGROUND
  Door to balloon time is important in the outcome of ST-elevation myocardial infarction treated with primary percutaneous intervention. This review summarizes prognostic factors for door to balloon time in STEMI patients presenting to a PCI capable hospital.
  
  
  METHODS
  NLM Gateway and Cochrane CENTRAL are the primary data sources. Searched reports were screened by title and abstract and full texts were located for potentially relevant articles. References from the selected articles and relevant background papers were hand searched for additional reports. Articles were reviewed and assessed for risk of bias. The results are summarized without meta-analysis.
  
  
  RESULTS
  90 papers are included in the review. Individual study quality was variable but was generally low. A number of patient characteristics, hospital characteristics, physician characteristics, care processes and "other" factors were associated with door to balloon time. Prognostic factors for longer times include: pre-hospital delay in presentation, cerebrovascular disease, absence of chest pain, lower PCI volume and specialization hospital, lower sum ST elevation, absence of Q waves and left bundle branch block. Shorter times were associated with: presentation during regular hours, PCI in a more recent year, 24 hour on site cardiology, pre-hospital ECG, single call to central page to activate the catheterization lab, ER physician activating the cath lab, lab staff arriving within 20 min of paging and culprit vessel PCI before full diagnostic angiography.
  
  
  CONCLUSIONS
  Understanding prognostic factors for door to balloon time can likely lead to improved quality of care for STEMI.
authors.affiliation: University of Utah School of Medicine, Salt Lake City, UT, USA. michael.peterson@hsc.utah.edu
authors.forename: Michael C
authors.initials: MC
authors.lastname: Peterson
authors.forename: Tyler
authors.initials: T
authors.lastname: Syndergaard
authors.forename: Josh
authors.initials: J
authors.lastname: Bowler
authors.forename: Richmond
authors.initials: R
authors.lastname: Doxey
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome