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American College of Cardiology/American Heart Association guidelines recommend a door-to-balloon time (DTB) &lt;90 minutes for nontransferred patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention. Systems of care to achieve and sustain this DTB performance over several years have not been previously reported.

Sustaining Improvement in Door-to-Balloon Time Over 4 Years