Door-to-balloon delays before primary angioplasty in the Regional Acute Myocardial Infarction Registry of Brittany. An analysis of the Observatoire Regional Breton sur l'Infarctus du myocarde (ORBI)

Summary Background Minimizing delays to coronary reperfusion is critical in the management of acute myocardial infarction (AMI). Aims To determine delays in in-hospital management and factors associated with delays of over 45 min. Methods We analysed data from the Observatoire Regional Breton sur l’Infarctus, a registry of AMI patients admitted within 24 h of symptom onset (July 2007 to December 2008) to an interventional cardiology centre in Brittany. Prehospital delay was defined as time between first responder arrival at the patient and patient arrival at an interventional cardiovascular centre. In-hospital delay was defined as time between admission to the interventional cardiovascular centre and first balloon inflation. Patients were grouped according to duration of in-hospital delay (> 45 vs ≤ 45 min). Predictors of short in-hospital delay (≤ 45 min) were examined by logistic regression analysis. Results The analysis included 560 patients (mean age 60.7 ± 13 years; 443 men). Median delay between symptom onset and call for medical assistance was 50 min (mean 115 ± 180). Two-thirds ( n  = 371) of patients were admitted to hospital during working hours (08:00–20:00 h); 383 (68%) patients were managed by emergency medical services before admission. In-hospital delay was less than or equal to 45 min for 296 (53%) patients. The mean overall (pre- and in-hospital) delay was 140 (median 109) min. Direct admission to a catheterization laboratory and admission during working hours were independently correlated with short in-hospital delay (odds ratios 20.8 [ p p  = 0.004], respectively). Conclusions In Brittany, median in-hospital delay before treatment of AMI by primary angioplasty was over 45 min in 50% of patients. Overall, delays were longer than recommended, due to excessively long prehospital delays. Patient admission during working hours and direct admission to a catheterization laboratory were associated with short in-hospital delay.