Three doors, three locks: a domain-specific framework for the residual door-to-balloon gap in STEMI care
Year: 2026
Type: article
Abstract: Krishnan and colleagues report that 91% of STEMI patients at a large Indian tertiary centre received primary PCI within the 90-minute door-to-balloon (D2B) target, a meaningful achievement in contemporary STEMI care. Their analysis of the 9% who missed the target is equally valuable: delays distributed almost evenly across three categories, delayed informed consent, hemodynamic instability, and diagnostic ambiguity. We argue these categories are not interchangeable quality-improvement targets. They are mechanistically distinct problems requiring different solutions. We propose a conceptual, hypothesis-generating framework rather than a validated taxonomy. Future STEMI quality improvement efforts should categorize residual delays by domain rather than reporting them in aggregate, and should match interventions to the specific mechanism of delay.
Authors: Sajid Kadir, Travis Murphy
Institutions: AdventHealth Tampa, University of Miami
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7221722692