Abstract
Background:Current guidelines for ST-elevation myocardial infarction (STEMI) recommend performing primary percutaneous coronary intervention (PCI) within 90 min of hospital arrival. However, recent data suggest that, in a real-world setting, median door-to-balloon (DTB) time is closer to 180 minfor transferred patients with no more than 4 % of patients treated within 90 min. We conducted this retrospective observational study to assess time to treatment in patients undergoing primary PCI at Quebec Heart and Lung Institute (QHLI).
 
 Methods: Consecutive lytic-eligible patients undergoing primary PCI at QHLI for STEMI between April 2004 and March 2004 were included in the present analysis. The primary evaluation was DTB time measured from arrival at the first hospital to first balloon inflation. Clinical outcomes consisted of in-hospital death, reinfarction and bleeding. DTB times and hospital outcomes of patients transferred from referring hospitals were compared to patients presenting directly to QHLI.
 
 Results: During the study period, 203 lytic-eligible patients were treated with primary PCI and included in the present analysis. Sixty-nine patients presented directly to QHLI and 134 were transferred from other Quebec City hospitals. The median DTB time was 114 min in transferred patients, compared with 87 min for patients presenting directly to QHLI [P < 0.001]. DTB time was
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