title: The first-door-to-balloon time delay in STEMI patients undergoing interhospital transfer.
abstract: BACKGROUND
  Interhospital transfer delays for ST-elevation myocardial infarction (STEMI) patients requiring primary percutaneous coronary intervention (PCI) may be shortened by improved regional care systems. We evaluated the transfer process and first door-to-balloon (D1toB) time in STEMI patients who underwent interhospital transfer for primary PCI.
  
  
  RESULTS
  We evaluated the D1toB time in 1837 patients who underwent interhospital transfer for primary PCI from the Cardiovascular Disease Surveillance program in Korea. Only 29.3% of patients had a D1toB time less than 120 minutes, as recommended by the American College of Cardiology Foundation/American Heart Association guidelines for the management of STEMI. After adjusting for potential confounders, chest pain at presentation (adjusted odds ratio [AOR], 2.06; 95% confidence interval [CI], 1.18-3.83), transfer to a PCI center with an annual PCI volume greater than 200 (AOR, 1.35; 95% CI, 1.04-1.74), and higher urbanization level (AOR, 2.01 [95% CI, 1.40-2.91], for urban areas; AOR, 3.70 [95% CI, 2.59-3.83], for metropolitan areas) showed beneficial effects on reducing the D1toB time. The median length of stay in the referring hospital (D1LOS) and interhospital transport time were 50 (interquartile range [IQR], 30-100) minutes and 32 (IQR, 20-51) minutes, respectively. The median time interval from the door of the receiving hospital to balloon insertion was 55 (IQR, 40-79) minutes.
  
  
  CONCLUSIONS
  Patients with STEMI undergoing interhospital transfer did not receive definite care within the recommended therapeutic time window. Delays in the transfer process (length of stay in the referring hospital and interhospital transport time) were major contributors to the delay in the D1toB time.
authors.affiliation: Laboratory of Emergency Medical Service, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea. Electronic address: timthe@gmail.com.
authors.forename: Jeong Ho
authors.initials: JH
authors.lastname: Park
authors.affiliation: Laboratory of Emergency Medical Service, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea. Electronic address: arendt75@gmail.com.
authors.forename: Ki Ok
authors.initials: KO
authors.lastname: Ahn
authors.affiliation: Laboratory of Emergency Medical Service, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea. Electronic address: sdshin@snu.ac.kr.
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.affiliation: Laboratory of Emergency Medical Service, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: docchaster@gmail.com.
authors.forename: Won Chul
authors.initials: WC
authors.lastname: Cha
authors.affiliation: Laboratory of Emergency Medical Service, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea; Department of Emergency Medicine, Kyungpook National University College of Medicine, Daegu, Korea. Electronic address: realfreeman@hanmail.net.
authors.forename: Hyun Wook
authors.initials: HW
authors.lastname: Ryoo
authors.affiliation: Laboratory of Emergency Medical Service, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea. Electronic address: blueelf7@naver.com.
authors.forename: Young Sun
authors.initials: YS
authors.lastname: Ro
authors.affiliation: Laboratory of Emergency Medical Service, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. Electronic address: emkity@snubh.org.
authors.forename: Taeyun
authors.initials: T
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention; D062486:Public Health Surveillance; D056910:Republic of Korea; D013997:Time Factors