{
  "abstract": "Introduction Timely reperfusion therapy is crucial in ST-elevation myocardial infarction (STEMI) management. Primary percutaneous coronary intervention (PPCI) reduces mortality and morbidity, but delays significantly impact outcomes. UK guidelines recommend PPCI within 120 minutes of diagnosis. While demographic disparities in treatment times have been identified, system-wide delays remain underexplored. This study evaluates door-to-balloon (DTB) times in self-presenting STEMI patients at a non-PCI centre in North Wales and assesses the impact of age, sex, and socioeconomic deprivation.Methods Using the Myocardial Ischaemia National Audit Project (MINAP) database, we identified 96 self-presenting STEMI patients (Jan 2021–Apr 2024) who were transferred across North Wales from a non-PCI centre to a PCI centre. Key time points were recorded: door time, ECG time, referral acceptance, ambulance departure, PCI centre arrival, and balloon inflation. Statistical analysis used the Mann-Whitney U test for sex and age comparisons (≤65 vs. >65 years) and the Kruskal-Wallis test for socioeconomic disparities.Results Median DTB time was 183 minutes. From diagnosis, time to PCI was 124 minutes, exceeding the 120-minute target. Breakdown of median intervals:Non-PCI centre: Door-to-ECG (18.5 min), ECG-to-Referral (26 min), Referral-to-Departure (56 min).Interhospital transfer: 40 min.PCI centre: Door-to-Balloon (28 min).No significant differences in DTB times or its components were observed based on sex (p = 0.07 to 0.88), age (p = 0.13 to 0.95), or deprivation decile (p = 0.10 to 0.17). The referral-to-departure interval (56 min) was the largest contributor to delays.Conclusion System-level factors, rather than demographic disparities, are the primary cause of prolonged DTB times in self-presenting STEMI patients. Delays in ambulance dispatch following referral acceptance significantly impact treatment times. Addressing ambulance service pressures and streamlining transfer processes could improve STEMI care in North Wales.",
  "authors": [
    {
      "affiliations": [
        "NHS Wales"
      ],
      "name": "Haroon Urrehman"
    },
    {
      "affiliations": [
        "NHS Wales"
      ],
      "name": "Khalid Khan"
    },
    {
      "affiliations": [
        "NHS Wales"
      ],
      "name": "Megan Jenkins"
    },
    {
      "affiliations": [
        "NHS Wales"
      ],
      "name": "Richard Roberts"
    },
    {
      "affiliations": [
        "NHS Wales"
      ],
      "name": "Betsi Cadwaladr"
    }
  ],
  "title": "2-054 Impact of demographics on door-to-balloon time in self-presenting STEMI patients at a non-PCI centre in North Wales",
  "uid": "bee3b9a0-b770-5d69-8387-fa3bfda52b66"
}