الملخص الإنجليزي
Background: Door-to-balloon (DTB) time is a quality indicator for timely perfusion
during the primary percutaneous intervention (pPCI). American Heart Association/
American College of Cardiology (AHA/ACC) guidelines recommended a DTB time of ≤
90 minutes. Shorter DTB time is preferable to reduce the negative clinical outcomes.
Purpose: The purpose of this study was two fold: (a) to determine the variables that
influence the DTB time among patients with STEMI in Oman, and (b) to assess the
relationship between delayed DTB time and patients' health-related outcomes including
length of stay, crude in-hospital mortality rate, hospital stay cost, and left ventricular
ejection fraction.
Method: A cross-sectional retrospective study was conducted. All patients who presented
to the Emergency Department at two referral hospitals in Oman and underwent pPCI
during two years' periods (January 2018- December 2019) were included. Data were
collected using electronic patients medical records. Descriptive statistics including mean,
standard deviation, percentages, and frequencies were used to describe the DTB time.
Logistic regression was used to identify factors influencing delayed DTB time. Chi square and independent sample t-tests were used to examine the association between
delayed DTB time and length of stay, crude in-hospital mortality rate, hospital stay cost,
and left ventricular ejection fraction.
Results: A total of 426 patients were included. More than half of patients (57.7%) were
between 50 and 69 years old. Of the total patients, 81.7% were male. The mean DTB time
was 151.56 minutes. A total of 357(83.8%) patients had a DTB time of more than 90
minutes while only 69 (16.2%) patients had DTB time less than 90 minutes DTB. The
result of bivariate logistic regression showed that patients' presenting symptoms and
presenting time were the only significant factors associated with delayed DTB (p =
0.005). Patients presented with atypical symptoms were three times more likely to have
a delayed DTB time compared with patients presenting with typical symptoms (OR =
3.003, 95% CI: 1.409 -6.400, p = 0.004). In addition, patients presented with irregular
working time were two times more likely to have a delayed DTB time compared with
patients who presented to the Emergency Department at a regular time (OR = 2.291, 95%
CI: 1.284– 4.087, p = 0.005). The crude in-hospital mortality rate was 9.86%. Findings
showed there is no significant relationship between DTB time and clinical outcomes
including crude in-hospital mortality rate, length of stay, hospital stay cost and left
ventricular ejection fraction.
Conclusion: The study findings suggest that nurses need adequate training to recognize
patients with atypical versus typical symptoms to shorten DTB time. Moreover, to
achieve recommended DTB time, maintaining adequate staffing and following
recommended guidelines during both regular and irregular hours is highly recommended.
These findings can be used as a baseline for future studies and can inform strategies for
improving the quality of treatment for patients with STEMI.
