Improvement in Door-to-Balloon (D2B) Time in Acute ST-Elevation Myocardial Infarction Through the D2B Alliance

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Background: Currently, the door-to-balloon (D2B) times observed in clinical practice in Taiwan are different from those recommended by evidence-based guidelines. D2B Alliance, a countrywide initiative for quality supported by the Taiwan Joint Commission on Hospital Accreditation, sought to achieve the goal of administering treatment to 75% of patients with ST-elevation myocardial infarction (STEMI) within 90min of hospital presentation. Methods and Results: The current study was designed to be prospective, national, and multicenter. We conducted a longitudinal study of the D2B times recorded in 15 primary percutaneous coronary intervention centers and examined the changes caused by implementing the D2B Alliance strategies. A total of 1,726 patients were enrolled in the D2B Alliance and implementation of the D2B Alliance strategies resulted in a significant decrease in the average D2B times (128.8±42.9min vs. 83.2±16.2min; P<0.001) from those at baseline. By the end of the year-long study, the percentage of patients treated under 90min had increased from 46.2% to 80.1% in the hospitals enrolled in the D2B Alliance. Conclusions: Over the 1 year, hospitals enrolled in the D2B Alliance achieved the goal of reducing the D2B times of 75% of STEMI patients to less than 90min.