Primary Preventable Cause of Door-in to Door-out Time Delay in ST-elavation Miyocard Infarction: Physician Decision Time

Abstract

Aim: Door-in to door-out (DIDO) time is defined as the process of primary percutaneous coronary intervention after the first medical contact. In patients with ST-segment elevation myocardial infarction, this period commonly causes delays in the patient’s treatment. Our aim is to determine the preventable component among the components that make up the DIDO time. Materials and Methods: The study included 86 patients with ST-segment elevation myocardial infarction who were referred from non-percutaneous coronary intervention-capable hospitals to our percutaneous coronary intervention center. In this study, the DIDO time for transferred patients was divided into three determining components: the door-to-electrocardiography time, physician decision time (PDT), and time to referral. Results: The DIDO time was >30 min in 91.9% of 86 patients referred for primary percutaneous coronary intervention from non- percutaneous coronary intervention-capable hospitals. The mean DIDO time was 85 (3-233) minutes. The main component prolonging the DIDO time in all groups was the “PDT”, defined for the first time in this study, with a median of 49 (1-186) minutes. Conclusion: Thanks to the data we have uncovered, a time recommendation should be developed for each stage of the transfer comprising the DIDO components. Developing standard recommendations can help define and reinforce time standards to ultimately reduce DIDO times and improve patient care.

Keywords

• acute myocardial infarction
• door-in to door-out
• emergency department
• primary percutaneous coronary intervention
• interhospital transfer