Door-to-Balloon Times: The U.S. Earns a Pat on the Back

Since 2005, the U.S. Centers for Medicare and Medicaid Services (CMS) have publicly reported the annual percentage of patients who receive primary percutaneous coronary intervention (PCI) within recommended times after presentation with acute myocardial infarction (MI). These disclosures, along with professional-organization initiatives such as the American College of Cardiology Door-to-Balloon (D2B) Alliance and the American Heart Association Mission: Lifeline (launched in 2006 and 2007, respectively), have increased awareness of the importance of short D2B times. To assess changes in D2B times between 2005 and 2010, investigators analyzed hospital-reported CMS data on all patients with acute MI undergoing PCI; the analysis included about 50,000 patients per year.

The median D2B time fell from 96 to 64 minutes over the 6-year study period. The declines were greatest in the groups with the highest median D2B times in 2005: patients aged >75 (from 105 to 67 minutes), women (from 102 to 67 minutes), and blacks (from 111 to 69 minutes). The proportion of D2B times <90 minutes increased from 44% to 91%, and the proportion of D2B times <75 minutes increased from 27% to 70%. Hospital-level analyses produced similar results.