Determinants and In-Hospital Outcomes of Prolonged Door-to-Balloon Time Among STEMI Patients Undergoing Primary PCI at a Level II Catheterization Laboratory in a Resource-Limited Peripheral Setting

Abstract

Objectives: To identify patient-related and operational factors associated with prolonged door-to-balloon time (DTBT) and to evaluate the association between prolonged DTBT and in-hospital outcomes among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) in a Level II catheterization laboratory. Methodology: This prospective observational analytical study included consecutive adult patients presenting with acute STEMI and undergoing primary PCI during office hours. Participants were categorized into DTBT ≤90 minutes and DTBT >90 minutes. Data regarding demographic characteristics, cardiovascular risk factors, clinical severity indicators, operational workflow delays, and in-hospital outcomes were collected. Major adverse cardiovascular events (MACE) were defined as a composite of in-hospital death, heart failure, cardiogenic shock, cardiac arrest, and clinically significant arrhythmia. Results: A total of 120 patients were included, of whom 91 (75.8%) were male, with a mean age of 56.3 ± 12.3 years. Thirty patients (25.0%) experienced prolonged DTBT (>90 minutes). Patients with prolonged DTBT had significantly higher rates of heart failure (30.0% vs 2.2%), cardiogenic shock (13.3% vs 1.1%), cardiac arrest (10.0% vs 1.1%), arrhythmia (30.0% vs 3.3%), in-hospital mortality (13.3% vs 0%), and MACE (60.0% vs 6.7%) compared with patients achieving DTBT ≤90 minutes (all p<0.05). Delay in ECG acquisition, delay in consent, and Cath lab occupancy remained independently associated with prolonged DTBT in adjusted analyses. Prolonged DTBT was also independently associated with MACE (adjusted OR 19.94; 95% CI 6.40–62.06). Conclusion: A considerable proportion of STEMI patients undergoing primary PCI experienced prolonged DTBT, and delayed reperfusion was associated with significantly worse in-hospital outcomes. Early ECG acquisition, streamlined emergency consent procedures, and improved Cath lab workflow management may represent important quality improvement targets in resource-limited Level II catheterization laboratories.