Narrative review: updates and strategies for reducing door-to-balloon time in ST-elevation myocardial infarction care

Abstract

This narrative review aims to evaluate strategies for reducing door-to-balloon (D2B) time in ST-elevation myocardial infarction (STEMI) patients, focusing on pre-hospital, in-hospital, and technological innovations, as well as addressing challenges to ensure sustainability. We reviewed recent literature from 2004 onward, examining various approaches to streamline STEMI care and improve D2B time. The review encompasses pre-hospital interventions such as advanced ECG monitoring and pre-hospital alerts, in-hospital strategies such as standardized protocols and streamlined processes, and technological innovations such as automated ECG interpretation, mobile applications, and telemedicine. Pre-hospital strategies have demonstrated significant benefits in reducing D2B times through early diagnosis and rapid communication. In-hospital approaches, including the use of clinical pathways and decision support systems, contribute to minimizing delays and enhancing coordination among healthcare providers. Technological innovations, such as automated ECG systems and telemedicine, facilitate quicker diagnosis and treatment initiation. However, challenges such as resource limitations, staff turnover, and variability in care processes persist. Addressing these challenges through continuous quality improvement, standardized care protocols, and data-driven analytics is crucial for sustaining improvements. Effective reduction in D2B time in STEMI care requires a multifaceted approach involving pre-hospital and in-hospital strategies, as well as leveraging technological advancements. Overcoming challenges and ensuring sustainability demands ongoing commitment to quality improvement, resource management, and standardized protocols. By integrating these strategies, healthcare systems can enhance the timeliness of STEMI care and improve patient outcomes.