Factors associated with the failure to achieve door to balloon time ≤90 minutes in patients with ST-segment elevation myocardial infarction in an electrocardiogram triage system: a retrospective observational study

Abstract

Abstract Background Door to balloon time is a crucial factor of mortality in patients with ST-segment elevation myocardial infarction. However, the factors that contribute to failure of achieving door to balloon time ≤90 minutes in an electrocardiogram triage system remain unknown. Methods This single-center retrospective observational study collected data from consecutive patients with ST-segment elevation myocardial infarction from April 2016 to March 2021. The primary outcome was the failure to achieve door to balloon time ≤90 minutes. A multivariate logistic regression model was performed to predict factors associated with failure to achieve door to balloon time ≤90 minutes. Results In total, 190 eligible patients were included. Of these, the 139 (73.2%) patients with door to balloon time ≤90 minutes were significantly younger compared to those with door to balloon time >90 minutes (p=0.02). However, there was no significant difference in sex and timing of hospital arrival between the door to balloon time ≤90 and >90 minutes groups. Presence of chest pain and ambulance usage were significantly more frequent in patients with door to balloon time ≤90 minutes (p≤0.01, p=0.02, respectively). Multivariate analysis showed that absence of chest pain (adjusted odds ratio 4.76; 95% confidence interval, 2.04-11.1; p<0.01) and non-ambulance usage (adjusted odds ratio 3.53; 95% confidence interval, 1.57-7.94; p<0.01) are predictive factors of failure to achieve door to balloon time ≤90 minutes. Conclusion Patients without chest pain as the chief complaint or non-ambulance usage were significantly associated with the failure to achieve door to balloon time ≤90 minutes.