GENERAL COMMENTS

The present paper reports the results of a small (156) single center prospective nonrandomized interventional cohort study of patients with STEMI undergoing pPCI. The authors identified factors influencing time delays and made an effort shorting these delays and then again measured time delays in detail. Despite being limited by its small size and non-randomized design it provides some interesting potentially clinically important findings. The study shows that it is possible to reduce important delays through an active detailed approach.

There are a number of limitations that should clearly be acknowledged. Some important procedures were during the observational period. If the study was pre-defined why did you not perform all changes in practice between the two observational phases? Was any power calculation performed? Why did you include an unequal number of patients in the two study phases? Why did you include 156 patients? That is a small number for a fairly long period of time. Was there a patient selection? Where patients enrolled consecutively? If not- why? And what were the characteristics of the non-enrolled patients.

The authors speculate that the longer delay from cath lab arrival to open vessel increased due to a shift to radial access. There also happened to be more patients with a history of prior CABG in the latter period. That may also have delayed the invasive procedure.