The Impact of the Distance From the Interventional Cardiologist’s Home to the Hospital During Off Hours Amir Lotfi, * MD, Gaurav Alreja, MD, Mohammad Amin Kashef, MD, Gregory R. Giugliano, MD, SM, Jane Garb, MS, and Marc Schweiger, MD Objectives: The impact of the distance from the interventional cardiologist’s home to the hospital and door to balloon time (DTBT) Background: The importance of DTBT is highlighted by its inclusion as one of the core quality measures collected by the center for Medicare and Medicaid services and by the Joint commission on Accreditation of Healthcare organizations. We investigated the effect of time of day on the DTBT in patients having primary percutaneous coronary intervention (pPCI) and the impact of distance of the on call interventional cardiologist from the hospital on the DTBT and major adverse cardiac events (MACE) in patients undergoing pPCI during the off hours Methods: Patients enrolled in the study presented with STEMI either in the field or to the emergency department (ED) and underwent pPCI from October 2007 to July 2009 Results: Significant predictors of DTBT included a history of prior MI (P 5 0.001), prior percutaneous coronary intervention (P 5 0.021), prior coronary artery bypass grafting (P < 0.001), and history of diabetes mellitus (P 5 0.004). The strongest predictor of DTBT was on versus off hours. Mean DTB was 18.5 min greater during off hours (72 min) compared to on-hours (53.5 min). The distance from the cardiologist’s home to the hospital was not associated with DTBT on multivariable analysis (P 5 0.20) Conclusion: When pPCI is performed in a highly organized STEMI center with broad staff support and expertise in cardiac care, the increase in the DTBT during off hours was not asso- ciated with increase MACE rates. V C 2014 Wiley Periodicals, Inc. Key words: door to balloon time; ST segment elevation myocardial infarction; primary percutaneous coronary intervention; off and on hours INTRODUCTION Prompt restoration of the blood flow through the infarct-related coronary artery after myocardial infarc- tion is expected to improve left ventricular function and long-term survival [1]. Primary percutaneous coro- nary intervention (pPCI) is the reperfusion method of choice for treatment of an ST segment elevation myo- cardial infarction (STEMI) when readily available [2,3]. The importance of door to balloon time (DTBT) is highlighted by its inclusion as one of the core qual- ity measures collected by the center for Medicare and Medicaid services and by the Joint commission on Ac- creditation of Healthcare organizations {hospitalcom- pare.hhs.gov; jointcommision.org}. In a survey of 365 hospitals, several hospital strategies have been strongly associated with the mean reduction of DTBT in the performance of pPCI [4]. These include emergency medicine physicians activating the catheterization labo- ratory (8.2 min), a single call to a central page operator who activates the laboratory (13.8 min), emergency department activation of the catheterization laboratory while the patient is on route to the hospital (15.4 min), an attending cardiologist always on site (14.6 min), and real-time data feedback for emergency department and the catheterization laboratory staff (8.6 min). Although the presence of an in-house interventional cardiologist along with support staff during off hours may contribute to a reduction in DTBT [4], this strat- egy carries significant cost implications for hospitals in addition to a non-trivial impact to the satisfaction of health care professionals [5]. Varying outcomes have been reported among studies evaluating the difference Division of Cardiology, Baystate Medical Center, Tufts Univer- sity School of Medicine, Springfield, Massachusetts Conflict of interest: Nothing to report. *Correspondence to: Amir Lotfi, MD, Division of Cardiology, Springfield 4 Room 4641, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199. E-mail: amir.lotfi@bhs.org. Western New England Acute Myocardial Infraction Network Received 22 November 2013; Revision accepted 12 March 2014 DOI: 10.1002/ccd.25492 Published online 16 April 2014 in Wiley Online Library (wileyonlinelibrary.com) V C 2014 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions 84:950–954 (2014)