Impact of Routine Case Volume on Door-to-Device Time for Primary PCI Patients: The Concept of a Designated Primary PCI Cath Lab at a Large Volume Cardiac Center

Background: Timely management of acute ST-elevation myocardial infarction (STEMI) is crucial, as prolonged door-to-device (DTD) time is directly related to worse cardiac outcomes. Institutions aim to achieve optimal DTD times as a measure of quality improvement. Objective: This study aimed to evaluate the impact of a higher number of routine cases on the DTD time of acute STEMI patients presenting to a tertiary care cardiac center. Methods: This retrospective observational study was conducted at the Peshawar Institute of Cardiology (PIC) in Peshawar. A total of 371 patients presented with acute STEMI over a three-month period, of whom 258 were included in the detailed analysis. Patient data, including baseline characteristics, arrival time, and device time, were obtained from the hospital database. Patients were divided into three groups based on their presentation timing: Morning (08:00 am to 02:00 pm), Evening (02:00 pm to 08:00 pm), and Night (08:00 pm to 08:00 am). The primary endpoint was to calculate and compare DTD time between these groups and evaluate the impact of routine case volume, especially during daytime hours. Results: Out of the 258 patients studied, 194 (75.4%) were male, with a mean age of 58.2 ± 11.2 years. Hypertension was the most common risk factor, affecting 131 patients (50.7%). A higher number of cases presented during the night shift (n=99), followed by the evening (n=81) and morning shifts (n=78). The use of conventional right radial artery access (RRAA) was prevalent (n=239, 92.6%, p=0.032). The total mean DTD time was 90.78 ± 39.9 minutes, with shift-wise DTD times of 74.0 ± 29.6 minutes for the night shift, 98.97 ± 40.0 minutes for the evening shift, and 103.5 ± 44.0 minutes for the morning shift. Post-procedural TIMI-III flow was achieved in 90.9% of night shift patients, 86.4% of evening shift patients, and 82.0% of morning shift patients. Conclusion: A higher number of routine cases resulted in prolonged DTD time. Establishing a designated catheterization lab exclusively for primary PCIs could improve DTD times and patient outcomes.