DOOR-TO-BALLOON TIME AND PATIENT OUTCOMES WITH ACUTE MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION (STEMI): EVALUATION OF THE IMPACT OF CARE PATHWAYS IN THE PUBLIC HEALTH SYSTEM

Abstract

This review analyzes the impact of door to balloon time on clinical outcomes in patients with ST segment elevation myocardial infarction, highlighting how the organization of public health care pathways influences delays in reperfusion. Although door to balloon time is widely used as a quality indicator, evidence shows that isolated reductions in this interval do not consistently lead to proportional decreases in mortality. Studies demonstrate that total system delay, from first medical contact to reperfusion, has a stronger association with outcomes than intrahospital time alone. Structural and operational barriers such as slow triage, delayed electrocardiogram acquisition, and inefficient communication between teams remain major contributors to prolonged treatment times in public systems. In contrast, coordinated regional networks with early triage, efficient transport, early activation of the catheterization laboratory, and integrated protocols consistently improve access to reperfusion and reduce mortality. The findings reinforce that optimizing the entire continuum of care is essential for improving survival in this condition.