{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:59:33Z","timestamp":1785214773248,"version":"3.55.0"},"reference-count":36,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deanship of Scientific Research","award":["IPP:130-849-2026"],"award-info":[{"award-number":["IPP:130-849-2026"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: ST-elevation myocardial infarction (STEMI) complications are widespread and have a direct effect on the length of stay (LOS) and mortality of patients. Reperfusion therapy via Percutaneous Coronary Intervention mainly impacts outcomes within the first few hours. Consequently, delaying this procedure is a key concern in STEMI management. The door-to-balloon (D2B) time is a crucial predictor of clinical outcomes. This study investigates whether D2B time can predict post-STEMI complications and length of hospital stay, accounting for sociodemographic and clinical variables. Methods: This prospective observational study involved 536 patients with confirmed STEMI, recruited consecutively from 8 hospitals in Amman, Jordan. Patients were classified as delayed if their D2B time was \u22652 h. Logistic regression analyzed the impact of delay on complications, while multiple regression assessed how delay time affected LoS. Results: The median D2B time was 108 min (IQR 65\u2013395). The delayed group and patients with a previous AMI had 2.22- and 1.41-times higher risks of complications, respectively, compared to their counterparts. Patients with a history of HTN and DM faced 1.24- and 1.18-times higher risks of complications versus their respective groups. Each additional hour of door-to-balloon delay was associated with an increase of 0.294 days in hospital length of stay. Conclusions: D2B \u2265 2 h is linked to increased complications and longer LoS. Timely management can reduce complications, shorten LoS, and lower hospital resource use.<\/jats:p>","DOI":"10.3390\/jcm15155839","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T09:47:41Z","timestamp":1785145661000},"page":"5839","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Door-to-Balloon Delay with Complications and Length of Hospital Stays in Patients with ST-Elevation Myocardial Infarction"],"prefix":"10.3390","volume":"15","author":[{"given":"Mohannad","family":"Eid AbuRuz","sequence":"first","affiliation":[{"name":"Basic Nursing Department, Faculty of Nursing, Yarmouk University, Irbid 21163, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1008-8216","authenticated-orcid":false,"given":"Fatma Refaat","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates"},{"name":"Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria 21526, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9978-1721","authenticated-orcid":false,"given":"Nizar","family":"Alsubahi","sequence":"additional","affiliation":[{"name":"Department of Health Service and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5530-3816","authenticated-orcid":false,"given":"Haya","family":"Ibrahim Ali Abu Maloh","sequence":"additional","affiliation":[{"name":"Clinical Nursing Department, Faculty of Nursing, Applied Science Private University, Amman 11973, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad Rajeh","family":"Saifan","sequence":"additional","affiliation":[{"name":"Basic Nursing Department, Faculty of Nursing, Yarmouk University, Irbid 21163, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8473-2093","authenticated-orcid":false,"given":"Mohannad","family":"Alkhateeb","sequence":"additional","affiliation":[{"name":"Department of Health Service and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3268-2259","authenticated-orcid":false,"given":"Osama","family":"Alkouri","sequence":"additional","affiliation":[{"name":"Basic Nursing Department, Faculty of Nursing, Yarmouk University, Irbid 21163, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"ref_1","first-page":"e41","article-title":"2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association","volume":"151","author":"Martin","year":"2025","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S0140-6736(19)32008-2","article-title":"Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): A prospective cohort study","volume":"395","author":"Yusuf","year":"2020","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Salari, N., Morddarvanjoghi, F., Abdolmaleki, A., Rasoulpoor, S., Khaleghi, A.A., Hezarkhani, L.A., Shohaimi, S., and Mohammadi, M. (2023). The global prevalence of myocardial infarction: A systematic review and meta-analysis. BMC Cardiovasc. Disord., 23.","DOI":"10.1186\/s12872-023-03231-w"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1001\/jama.2023.1699","article-title":"Differences in treatment patterns and outcomes of acute myocardial infarction for low-and high-income patients in 6 countries","volume":"329","author":"Landon","year":"2023","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2633556521999570","DOI":"10.1177\/2633556521999570","article-title":"Trends in the magnitude of chronic conditions in patients hospitalized with a first acute myocardial infarction","volume":"11","author":"Tisminetzky","year":"2021","journal-title":"J. Multimorb. Comorbidity"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1136\/heartjnl-2018-313398","article-title":"Implementing myocardial infarction systems of care in low\/middle-income countries","volume":"105","author":"Nascimento","year":"2019","journal-title":"Heart"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1038\/nrcardio.2017.138","article-title":"Cardiovascular disease in the Eastern Mediterranean region: Epidemiology and risk factor burden","volume":"15","author":"Sarrafzadegan","year":"2018","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"AbuRuz, M.E. (2018). Perceived control moderates the relationship between anxiety and in-hospital complications after ST segment elevation myocardial infarction. J. Multidiscip. Healthc., 359\u2013365.","DOI":"10.2147\/JMDH.S170326"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12872-019-1126-z","article-title":"Patients with ST segment elevation myocardial infarction: Moderating effect of perceived control on the relationship between depression and in-hospital complications","volume":"19","author":"AbuRuz","year":"2019","journal-title":"BMC Cardiovasc. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.jacc.2015.11.048","article-title":"Post-hospital outcomes of patients with acute myocardial infarction with cardiogenic shock: Findings from the NCDR","volume":"67","author":"Shah","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"843","DOI":"10.21037\/cdt-22-611","article-title":"Door-to-device time and mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention: Insight from real world data of Thai PCI Registry","volume":"13","author":"Champasri","year":"2023","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0140-6736(78)90500-7","article-title":"Transluminal dilatation of coronary artery stenosis","volume":"1","author":"Gruenzig","year":"1978","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1056\/NEJMra1210816","article-title":"Drug-eluting coronary-artery stents","volume":"368","author":"Stefanini","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e78","DOI":"10.1016\/j.jacc.2012.11.019","article-title":"2013 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines","volume":"61","author":"Kushner","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e012188","DOI":"10.1161\/JAHA.119.012188","article-title":"Prognostic implications of door-to-balloon time and onset-to-door time on mortality in patients with ST-segment\u2013elevation myocardial infarction treated with primary percutaneous coronary intervention","volume":"8","author":"Park","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"19978","DOI":"10.1038\/s41598-019-56353-7","article-title":"Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: A retrospective cohort study","volume":"9","author":"Foo","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.accreview.2003.10.055","article-title":"ZWOLLE Myocardial Infarction Study Group. Symptom-onset-to-balloon time and mortality in patients with acute myocardial infarction treated by primary angioplasty","volume":"13","author":"Luca","year":"2004","journal-title":"ACC Curr. J. Rev."},{"key":"ref_19","first-page":"131","article-title":"The impact of time-to-balloon on outcomes in patients undergoing modern primary angioplasty for acute myocardial infarction","volume":"48","author":"Soon","year":"2007","journal-title":"Singap. Med. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"357","DOI":"10.3346\/jkms.2008.23.3.357","article-title":"The impact of initial treatment delay using primary angioplasty on mortality among patients with acute myocardial infarction: From the Korea acute myocardial infarction registry","volume":"23","author":"Song","year":"2008","journal-title":"J. Korean Med. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.2169\/internalmedicine.4287-19","article-title":"Association between the door-to-balloon time and mid-term clinical outcomes in patients with ST-segment elevation myocardial infarction","volume":"59","author":"Tsukui","year":"2020","journal-title":"Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.amjcard.2010.02.029","article-title":"Effect of onset-to-door time and door-to-balloon time on mortality in patients undergoing percutaneous coronary interventions for ST-segment elevation myocardial infarction","volume":"106","author":"Hannan","year":"2010","journal-title":"Am. J. Cardiol."},{"key":"ref_23","first-page":"422","article-title":"Door-to-balloon time and mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty","volume":"7","author":"Karkabi","year":"2021","journal-title":"Eur. Heart J.-Qual. Care Clin. Outcomes"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1136\/heartjnl-2017-312517","article-title":"Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: A meta-analysis","volume":"104","author":"Foo","year":"2018","journal-title":"Heart"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ehj.2017.01.002","article-title":"Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care","volume":"69","author":"Youssef","year":"2017","journal-title":"Egypt. Heart J."},{"key":"ref_26","unstructured":"(2024, March 29). Sample Size Calculator. Available online: https:\/\/clincalc.com\/stats\/samplesize.aspx."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.repc.2019.07.007","article-title":"Patient and system delays in the treatment of acute coronary syndrome","volume":"39","author":"Viana","year":"2020","journal-title":"Rev. Port. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Task Force Members, Steg, P.G., James, S.K., Atar, D., Badano, L.P., Lundqvist, C.B., Borger, M.A., Di Mario, C., Dickstein, K., and Ducrocq, G. (2012). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur. Heart J., 33, 2569\u20132619.","DOI":"10.1093\/eurheartj\/ehs215"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Cader, F.A., Banerjee, S., and Gulati, M. (2022). Sex Differences in Acute Coronary Syndromes: A Global Perspective. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9080239"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.15420\/ecr.2023.45","article-title":"Symptomology, Outcomes and Risk Factors of Acute Coronary Syndrome Presentations without Cardiac Chest Pain: A Scoping Review","volume":"19","author":"Perona","year":"2024","journal-title":"Eur. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1017\/S1049023X23006039","article-title":"Factors Associated with Symptom-to-Door Delay in Patients with ST-Segment Myocardial Infarction: A Systematic Review","volume":"38","author":"Lu","year":"2023","journal-title":"Prehospital Disaster Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Murg, S.I., Mati\u0219, L., Moldovan, A.F., and Popovici, D.I. (2025). Association Between Advanced TNM Stages and Increased Risk of Cardiac Dysfunction in Patients with LVEF < 50. Medicina, 61.","DOI":"10.3390\/medicina61020301"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1097\/JCN.0000000000000375","article-title":"Gender differences in anxiety and complications early after acute myocardial infarction","volume":"32","author":"AbuRuz","year":"2017","journal-title":"J. Cardiovasc. Nurs."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"205","DOI":"10.2174\/1874434601812010205","article-title":"Depressive symptoms and complications early after acute myocardial infarction: Gender differences","volume":"12","author":"AbuRuz","year":"2018","journal-title":"Open Nurs. J."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Maida, C.D., Daidone, M., Pacinella, G., Norrito, R.L., Pinto, A., and Tuttolomondo, A. (2022). Diabetes and Ischemic Stroke: An Old and New Relationship an Overview of the Close Interaction between These Diseases. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23042397"},{"key":"ref_36","first-page":"22","article-title":"The connection between hypertension and diabetes and their role in heart and kidney disease development","volume":"29","author":"Hezam","year":"2024","journal-title":"J. Res. Med. Sci. Off. J. Isfahan Univ. Med. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5839\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:11:13Z","timestamp":1785211873000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5839"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,26]]},"references-count":36,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15155839"],"URL":"https:\/\/doi.org\/10.3390\/jcm15155839","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,26]]}}}