Achieving door-to-balloon time ≤ 90 minutes in ST-elevation myocardial infarction: a retrospective clinical audit from a tertiary care centre in India

Timely reperfusion therapy with primary percutaneous coronary intervention (PCI) significantly improves outcomes in ST-elevation myocardial infarction (STEMI). International guidelines recommend achieving a door-to-balloon (D2B) time of ≤ 90 min in at least 90% of eligible patients. This audit aimed to evaluate institutional adherence to this benchmark at a tertiary care center in India. 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 presenting directly to the emergency department (ED) who underwent primary PCI were included. STEMI was diagnosed based on clinical presentation, 12-lead ECG showing ≥ 1 mm ST-segment elevation in ≥ 2 contiguous leads, and confirmed by cardiology consultation. Patients treated with thrombolysis, those with contraindications to PCI, or those transferred from peripheral facilities were excluded. Key time points ED arrival (door time defined as time of triage registration), ECG acquisition, PCI decision, and balloon inflation were recorded from electronic timestamps in the hospital information system and validated by two independent auditors. The primary outcome was the proportion achieving D2B time ≤ 90 min. Among 657 STEMI patients presenting to the ED, 620 (94.4%) underwent primary PCI. Of these, 564 patients (91.0%; 95% CI: 88.4–93.2%) achieved a D2B time within 90 min, meeting the international benchmark. The mean D2B time was 76 ± 9.4 min. Delays beyond 90 min were noted in 56 patients (9.0%), primarily due to delayed consent (37.5%), need for hemodynamic stabilization (32.1%), and diagnostic ambiguity (30.4%). This audit confirmed that coordinated STEMI care at our center achieved the international D2B benchmark in 91% of eligible patients. Consent pathway optimization, enhanced triage protocols, and continuous team training are recommended to further reduce delays and improve outcomes.