Association of Door-to-Balloon Delay with Complications and Length of Hospital Stays in Patients with ST-Elevation Myocardial Infarction

Q: What are the key findings of this study?

A door-to-balloon delay of 2 hours or more was associated with a significantly higher risk of in-hospital complications (OR 2.22) compared to a delay of less than 2 hours in patients with STEMI.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: ST-Elevation Myocardial Infarction (STEMI) (n=536). Intervention: Door-to-balloon delay ≥ 2 hours vs. Door-to-balloon time < 2 hours. Primary outcome: In-hospital complications (OR 2.22, 95% CI 1.31-4.22, p=0.003).

Q: What does this research mean for the field?

A door-to-balloon time of 2 hours or more is associated with a 2.22-fold increased risk of complications and an increase of 0.294 days in hospital length of stay per additional hour of delay in patients with STEMI. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mohannad Eid AbuRuz; Fatma Refaat Ahmed; Nizar Alsubahi; Haya Ibrahim Ali Abu Maloh; Ahmad Rajeh Saifan; Mohannad Alkhateeb; Osama Alkouri

doi:10.3390/jcm15155839

July 26, 2026Journal of Clinical MedicineOpen Access

Association of Door-to-Balloon Delay with Complications and Length of Hospital Stays in Patients with ST-Elevation Myocardial Infarction

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Key result

Door-to-balloon time ≥2 hours is linked to ~122% higher in-hospital complication risk in STEMI.

OR 2.22
95% CI 1.31-4.22
P=0.003
n=536

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Why the study?

Delaying percutaneous coronary intervention is a key concern in STEMI management, prompting investigation into whether door-to-balloon time predicts post-STEMI complications and hospital length of stay.

Does a door-to-balloon delay of ≥2 hours increase in-hospital complications and length of stay in patients with STEMI?

Key Points

To determine whether door-to-balloon delay of two hours or more predicts post-ST-elevation myocardial infarction complications and longer hospital stays while accounting for clinical and sociodemographic factors.
Prospective observational study of 536 consecutive patients with confirmed ST-elevation myocardial infarction recruited from 8 hospitals in Amman, Jordan.
Patients were categorized as delayed if door-to-balloon time was ≥2 hours (n=226) versus no-delay (<2 hours, n=310).
Logistic regression evaluated independent predictors of complications, and stepwise linear regression assessed hospital length of stay.
Complications developed in 32.3% (73/226) of the delayed group compared to 23.2% (72/310) of the no-delay group, with a door-to-balloon delay ≥2 hours independently raising complication risk (OR 2.22, 95% CI 1.31–4.22, p=0.003).
Additional independent predictors of complications were previous acute myocardial infarction (OR 1.41, 95% CI 1.22–1.98, p=0.005), hypertension (OR 1.24, 95% CI 1.11–1.48, p=0.006), and diabetes (OR 1.18, 95% CI 1.06–1.39, p=0.007).
Each additional hour of door-to-balloon delay extended hospital stay by 0.294 days (95% CI 0.211–0.377, p<0.001), with total hospital stay averaging 8.04 ± 5.44 days in delayed patients versus 4.40 ± 2.84 days in non-delayed patients (p<0.001).

Study Design

Type

Observational (n=536)

Multicenter

Yes

Structured PICO

Does a door-to-balloon delay of ≥2 hours increase in-hospital complications and length of stay in patients with STEMI?

P

Population

536 adult patients with confirmed STEMI undergoing primary PCI within 12 hours of diagnosis, free of prior heart failure or cardiogenic shock, followed during their hospital stay.

E

Exposure

Delayed door-to-balloon (D2B) time (≥2 hours / 120 minutes)

C

Comparator

Non-delayed door-to-balloon (D2B) time (<2 hours / 120 minutes)

O

Outcome

In-hospital complications (composite of reinfarction, acute recurrent ischemia, ventricular fibrillation, sustained ventricular tachycardia, supraventricular tachyarrhythmia with hemodynamic instability, in-hospital death, acute pulmonary edema, and cardiogenic shock) and length of hospital stay (LoS)composite

Main Result

Odds Ratio: 2.22 (95% CI 1.31–4.22)

Absolute Event Rate: 32.3% vs 23.2%

p-value: p=0.003

Limitations

Potential errors in medical record abstraction
Observational design limits causal inference
Unmeasured confounding factors
Hospital-level characteristics were not collected
Abstraction from medical records occasionally erroneous
Observational study cannot establish cause-and-effect
Unmeasured factors/residual confounding
Variable selection for multivariable models based on bivariate associations (age, sex, LVEF not retained)

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Implication

A door-to-balloon time of ≥2 hours in STEMI patients is significantly associated with an increased risk of in-hospital complications and prolonged length of stay.

Abstract

Background: ST-elevation myocardial infarction (STEMI) complications are widespread and have a direct effect on the length of stay (LOS) and mortality of patients. Reperfusion therapy via Percutaneous Coronary Intervention mainly impacts outcomes within the first few hours. Consequently, delaying this procedure is a key concern in STEMI management. The door-to-balloon (D2B) time is a crucial predictor of clinical outcomes. This study investigates whether D2B time can predict post-STEMI complications and length of hospital stay, accounting for sociodemographic and clinical variables. Methods: This prospective observational study involved 536 patients with confirmed STEMI, recruited consecutively from 8 hospitals in Amman, Jordan. Patients were classified as delayed if their D2B time was ≥2 h. Logistic regression analyzed the impact of delay on complications, while multiple regression assessed how delay time affected LoS. Results: The median D2B time was 108 min (IQR 65–395). The delayed group and patients with a previous AMI had 2.22- and 1.41-times higher risks of complications, respectively, compared to their counterparts. Patients with a history of HTN and DM faced 1.24- and 1.18-times higher risks of complications versus their respective groups. Each additional hour of door-to-balloon delay was associated with an increase of 0.294 days in hospital length of stay. Conclusions: D2B ≥ 2 h is linked to increased complications and longer LoS. Timely management can reduce complications, shorten LoS, and lower hospital resource use.

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Cite This Study

AbuRuz et al. (2026) conducted an observational in ST-Elevation Myocardial Infarction (STEMI) (n=536). Door-to-balloon delay ≥ 2 hours vs. Door-to-balloon time < 2 hours was evaluated on In-hospital complications (OR 2.22, 95% CI 1.31-4.22, p=0.003). A door-to-balloon delay of 2 hours or more was associated with a significantly higher risk of in-hospital complications (OR 2.22) compared to a delay of less than 2 hours in patients with STEMI.

synapsesocial.com/papers/6a69a2e2c8da07d9defa6e08 https://doi.org/10.3390/jcm15155839

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Association of Door-to-Balloon Delay with Complications and Length of Hospital Stays in Patients with ST-Elevation Myocardial Infarction

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association of Door-to-Balloon Delay with Complications and Length of Hospital Stays in Patients with ST-Elevation Myocardial Infarction

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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