Evaluation of Door‑To‑Balloon Time for Performing Primary Percutaneous Coronary Intervention in ST‑Segment Elevation Myocardial Infarction Patients Transferred by Pre‑Hospital Emergency System in Tehran

Leili Yekefallah, Mahdi Pournorooz, Hassan Noori, Mahmood Alipur


Background: The suggested treatment for patients with ST‑segment elevation is the Primary Percutaneous Coronary Intervention (PPCI) for coronary reperfusion. This study aimed to evaluate the contribution of pre‑hospital and hospital emergency systems in the interval time for PPCI among patients with the ST‑segment elevation myocardial infarction (STEMI) in selected hospitals of Tehran city.

Materials and Methods: This cross‑sectional study was carried out on patients with typical chest pain transferred to the emergency wards of three large general hospitals in Tehran city by Emergency Medical Services. They received the PPCI. The information about admission time to the triage, time of conducting electrocardiography (ECG), diagnosis time of STEMI, and time of the PPCI were recorded and analyzed using descriptive and inferential statistics.

Results: In this study, 121 patients were evaluated, and of which 94 (77.68%) were men and 27 (22.32%) were women. The average time (SD) of patient admission in the triage until to receive the PPCI (door‑to‑balloon) was 104.60 (62.30) min.

Conclusions: The door‑to‑balloon time was 104.60 min. If ECG is taken by pre‑hospital emergency nursing staff and diagnosis of STEMI is performed by the pre‑hospital emergency service, and the patient is delivered directly to the angiography department, the door‑to‑balloon time is significantly reduced.


Door‑to‑balloon, emergency care information systems, percutaneous coronary intervention, ST‑segment elevation myocardial infarction

Full Text:



Nicholas M, Townsend N, Scarborough P, Rayner M. Corrigendum to: Cardiovascular disease in Europe 2014: Epidemiological update. Eur Heart J 2015;36:794.

Home D. Heart Disease Fact Sheet. wwwCDCcom. 2014. Available from: https://www.cdc.gov/dhdsp/data_statistics/fact_ sheets/fs_heart_disease.htm. [Last accessed on 2014 Jan 09].

Momeni M, Salari A, Ghanbari A, Rostamnia L. Hospital mortality of patients with acute myocardial infarction and related factor. J North Khorasan Univ Med Sci 2014;6:407‑14.

Keykha S. Electrocardiography results in patients with acute coronary syndrome. J Iran Emergency Med 2015;2:1.

Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. [ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‑segment elevation. The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST‑segment elevation of the European Society of Cardiology (ESC)]. G Ital Cardiol 2012;13:171‑228.

Beek R HT, Pollak A, Raham M, Stephen J. Text book of Intermediate emergency care and transportation of the sick and injured 2012.

Park YH, Kang GH, Song BG, Chun WJ, Lee JH, Hwang SY, et al. Factors related to prehospital time delay in acute ST‑segment elevation myocardial infarction. J Korean Med Sci 2012;27:864‑9.

Bolvardi E, Reihani H, Pishbin E, Sanei A, Ebrahimi M. Comparison of educational effectiveness between lecture and demonstration based methods on emergency medical services providers of Mashhad city in dealing with patients suspected of having acute coronary syndrome. Med J Mashhad Univ Med Sci 2014;57:711‑8.

Estevez‑Loureiro R, Calvino‑Santos R, Vazquez‑Rodriguez JM, Marzoa‑Rivas R, Barge‑Caballero E, Salgado‑Fernandez J, et al. Direct transfer of ST‑elevation myocardial infarction patients for primary percutaneous coronary intervention from short and long transfer distances decreases temporal delays and improves short‑term prognosis: The PROGALIAM Registry. EuroIntervention 2010;6:343‑9.

Mahabadi A, Ketabi S, Sajadi S. Investigate the parameters which affect the patients waiting time in the emergency department of orthopedic services in ayatollah kashani hospital with the lean management approach. Health Inf Manage 2015;11:1016‑25.

Zavareh K, Mahmoodlou F, Bidgoli M. Exploring factors affecting uality of emergency department service delivery based on client perception. J Urmia Nurs Midwifery Faculty 2015;13:25‑36.

Hoseinian A, Pourfarzi F, Sepahvand N, Habibzadeh S, Babapour B, Doostkami H, et al. The study of interval between onset of the clinical symptoms and streptokinase receiving in patients with acute myocardial infarction. J Ardabil Univ Med Sci 2012;12:16‑24.

Mann DL, Zipes DP, Libby P, Bonow RO. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th Edition, Saunders: Elsevier Health Sciences. 2015;1:1095.

Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The task force on myocardial revascularization of the European society of cardiology (ESC) and the European association for cardio‑thoracic surgery (EACTS) developed with the special contribution of the European association of percutaneous cardiovascular interventions (EAPCI). Eur Heart J 2014;35:2541‑619.

Amini A, Namazi MH, Safi M, Saadat H, Vakili H, Mohammadi A. Incidence and associated factors of no‑reflow phenomenon in STEMI patients treated with primary PCI. Iran South Med J 2010;13:171‑9.

Menees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door‑to‑Balloon Time and Mortality among Patients Undergoing Primary PCI. N Engl J Med 2013;369:901‑9.

Cannon CP, Braunwald E. Time to reperfusion: The critical modulator in thrombolysis and primary angioplasty. J Thromb Thrombolysis 1996;3:117‑25.

Rajabi‑Moghadam H, Raygan F, Nourddini M, Mousavi SG, Taghadosi M, Zahedi M. Evaluating in‑hospital delay for fibrinolytic therapy of myocardial infarction patients with acute ST‑elevation in Kashan Shahid‑Beheshti hospital during 2007‑2010. Feyz J Kashan Univ Med Sci 2012;16:468‑75.

Loh JP, Satler LF, Pendyala LK, Minha S, Frohna WJ, Torguson R, et al. Use of emergency medical services expedites in‑hospital care processes in patients presenting with ST‑segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiovasc Revasc Med 2014;15:219‑25.

Chan AW, Kornder J, Elliott H, Brown RI, Dorval JF, Charania J, et al. Improved survival associated with pre‑hospital triage strategy in a large regional ST‑segment elevation myocardial infarction program. JACC Cardiovasc Interv 2012;5:1239‑46.

Kassaian SE, Masoudkabir F, Sezavar H, Mohammadi M, Pourmoghaddas A, Kojuri J, et al. Clinical characteristics, management and 1‑year outcomes of patients with acute coronary syndrome in Iran: The Iranian project for assessment of coronary events 2 (IPACE2). BMJ Open 2015;5:e007786.

Rafiee H, Beik Felk B, Mirzaee M, Bani Tabaiee M, Bayat A. Examination of the waiting time for receiving services and related factors with it in referents to the Ayatollah Kashani hospital emergency of ShahrKord. Health Nurs Midwifery Mag 2014;1:7‑1.


  • There are currently no refbacks.