Door-to-Balloon Time in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) in Iran: A Systematic Review and Meta-Analysis

Shahram  Kargar; Hamideh  Ebrahimi; Ali  Sahebi

doi:10.18502/jthc.v21i2.21693

Shahram Kargar Department of Cardiology, School of Medicine, Ilam University of Medical sciences, Ilam, Iran.
Hamideh Ebrahimi Lahore School of Nursing, the University of Lahore, Lahore, Pakistan.
Ali Sahebi Department of Medical Emergencies and Health in Disasters and Emergencies, Ilam University of Medical Sciences, Ilam, Iran.

DOI: https://doi.org/10.18502/jthc.v21i2.21693

Keywords: Door-to-Balloon Time; ST-Segment Elevation Myocardial Infarction (STEMI); Primary Percutaneous Coronary Intervention; Systematic Review; Meta-Analysis; Iran

Abstract

Background: Myocardial infarction is a severe cardiovascular condition that necessitates prompt reperfusion therapies, particularly primary percutaneous coronary intervention (PCI), to prevent irreversible myocardial damage and associated complications. This study aimed to determine the average door-to-balloon (D2B) time in Iranian hospital emergency departments through a systematic review and meta-analysis.

Methods: Following the PRISMA guideline, the protocol for this study was registered in PROSPERO (CRD420251171966). A comprehensive search with no time restrictions was conducted through the end of September 2025 in data resources such as PubMed, Scopus, Web of Science, Google Scholar, SID, and Magiran. A random-effects model was used for the meta-analysis, and heterogeneity among studies was assessed using the I² index. Publication bias was evaluated with Begg test.

Results: Of 154 initial articles retrieved, 13 studies met the eligibility criteria and were included in the final analysis. The pooled mean D2B time was 85.05 minutes (95% CI, 75.32 to 94.78). A significant level of heterogeneity was observed among the included studies. Meta-regression analysis indicated a decreasing trend in D2B time over the years.

Conclusion: The results of this study indicate that the average D2B time in Iran aligns with global standards. However, significant variability among hospitals highlights systemic gaps in STEMI care. Addressing these gaps requires coordinated emergency-PCI teams, nationwide 24/7 services, ongoing training, and uniform quality standards.