Assessing the 90-Minute Door-to-Device Benchmark in PPCI for Acute STEMI: A Comparative Study of On-Hours and Off-Hours in a Tertiary Hospital

Abstract

Objectives: To compare door-to-device times during on-hours and off-hours among patients presenting with acute ST-Elevation Myocardial Infarction (STEMI) who underwent Primary Percutaneous Coronary Intervention (PPCI). Methodology: This descriptive cross-sectional study was conducted at Rawalpindi Institute of Cardiology, Rawalpindi, from August 2024 to January 2025. A total of 200 patients, aged 30 to 75 years regardless of gender, presenting with acute STEMI within 12 hours of symptom onset and undergoing PPCI, were enrolled. The interval from patient arrival at the emergency department to first device activation during PPCI was carefully recorded, alongside the timing of the procedure categorized as on-hours or off-hours. Results: Of the 200 participants, 82.0% were male, with a mean age of 56.49±10.65 years. A majority, 143 (71.5%), achieved a door-to-device time of ≤90 minutes, with a composite median door-to-device time of 69.50 (IQR 54.00–94.00) minutes. Although the median door-to-device time was slightly longer during off-hours compared to on-hours [72.00 (58.00–92.50) vs. 66.50 (51.00–96.50) minutes], this difference was not statistically significant (p>0.05). However, patients meeting the ≤90-minute target during both on-hours and off-hours showed significantly shorter times (p<0.001). Conclusion: Timely PPCI can be consistently achieved in a tertiary care setting regardless of whether patients present during on-hours or off-hours.