Achieving Door-to-Balloon Time ≤90 Minutes in ST-Elevation Myocardial Infarction (STEMI): Results of a Retrospective Audit

Background Timely reperfusion therapy with primary percutaneous coronary intervention (PCI) significantly improves outcomes in ST-elevation myocardial infarction (STEMI). Current international guidelines recommend achieving a door-to-balloon (D2B) time of ≤ 90 minutes in at least 90% of eligible patients. This audit aimed to evaluate institutional adherence to this benchmark at a tertiary care center in India. Methods A retrospective clinical audit was conducted at SRM Medical College Hospital and Research Centre over a 12-month period (January–December 2024). All adult STEMI patients who underwent primary PCI were included. Patients treated with thrombolysis or with non-system-related delays were excluded. Key time points, including emergency department (ED) arrival, ECG, PCI decision, and balloon inflation, were analyzed. The primary outcome was the percentage of patients achieving D2B time ≤ 90 minutes. Results Among 657 STEMI patients presenting to the ED, 620 (94.4%) were taken for primary PCI. Of these, 564 patients (91.0%) achieved a D2B time within 90 minutes, meeting the international benchmark. Delays beyond 90 minutes were noted in 56 patients (9.0%), primarily due to delayed consent (37.5%), need for medical stabilization (32.1%), and diagnostic ambiguity (30.4%). Conclusion The audit confirmed that coordinated STEMI care at our center achieved the international D2B benchmark in 91% of eligible patients. However, system and patient-level delays remain a challenge. Interventions such as rapid consent pathways, enhanced triage protocols, and continuous team training are recommended to further reduce treatment delays and optimize patient outcomes.