Optimization of Door-to-Balloon Time Implementing a Process Improvement Program. Results after 5 Years

Abstract

Background: If available, primary transluminal coronary angioplasty (PTCA), performed timely and in experienced sites, is the best reperfusion strategy for ST elevation myocardial infarction (STEMI). The door-to-balloon (DTB) time expresses operational efficiency of the site in charge of the PTCA, with an impact on patient’s progress. The aim of this study was to analyze the long-term results of a continuous improvement program for the DTB time process. Methods: Patients diagnosed with STEMI who had undergone PTCA from January 2015 to May 2022 were prospectively and consecutively enrolled. The population was divided in two periods: an immediate implementation period and a long-term follow-up period. Results: 671 patients were prospectively and consecutively enrolled. During the implementation period (P1) 91 patients were enrolled, and 580 during the program follow-up (P2) . The median (interquartile range, IQR) DTB time was 46 min (29-59) for P1 vs 42 min(25-52) for P2, p=0.055). The second period showed a reduction in pre-activations (P1 54,1% vs P2 30 %, p=0.02) and on-hour procedures (42% for P1 versus 30% for P2, p=0.029). Conclusion: The registry showed long-term maintenance of good results, despite reduced reactivations and on-hour procedures.