Abstract
IntroductionThe purpose of this multicenter study was to assess differences in demographics, medical history, treatment times, and follow-up status among patients with ST-elevation myocardial infarction (STEMI), who were transported to the hospital by emergency medical services (EMS) or by private vehicle, or were transferred from other medical facilities.MethodsThis multicenter study involved the collection of both retrospective and prospective data from 455 patients admitted to four hospitals in Abu Dhabi. We collected electronic medical records from EMS and hospitals, and conducted interviews with patients in person or via telephone. Chi-square tests and Kruskal–Wallis tests were used to examine differences in variables by mode of transportation.ResultsResults indicated significant differences in modes of transportation when considering symptom-onset-to-balloon time (p < 0.001), door-to-balloon time (p < 0.001), and health status at six-month and one-year follow-up (p < 0.001). Median times (interquartile range) for patients transported by EMS, private vehicle, or transferred from an outside facility were as follows: symptom-onset-to-balloon time in hours, 3.1 (1.8–4.3), 3.2 (2.1–5.3), and 4.5 (3.0–7.5), respectively; door-to-balloon time in minutes, 70 (48–78), 81 (64–105), and 62 (46–77), respectively. In all cases, EMS transportation was associated with a shorter time to treatment than other modes of transportation. However, the EMS group experienced greater rates of in-hospital events, including cardiac arrest and mortality, than the private transport group.ConclusionOur results contribute data supporting EMS transportation for patients with acute coronary syndrome. Although a lack of follow-up data made it difficult to draw conclusions about long-term outcomes, our findings clearly indicate that EMS transportation can speed time to treatment, including time to balloon inflation, potentially reducing readmission and adverse events. We conclude that future efforts should focus on encouraging the use of EMS and improving transfer practices. Such efforts could improve outcomes for patients presenting with STEMI.
Highlights
The purpose of this multicenter study was to assess differences in demographics, medical history, treatment times, and follow-up status among patients with ST-elevation myocardial infarction (STEMI), who were transported to the hospital by emergency medical services (EMS) or by private vehicle, or were transferred from other medical facilities
Median times for patients transported by EMS, private vehicle, or transferred from an outside facility were as follows: symptom-onsetto-balloon time in hours, 3.1 (1.8-4.3), 3.2 (2.1–5.3), and 4.5 (3.0–7.5), respectively; door-toballoon time in minutes, 70 (48–78), 81 (64–105), and 62 (46–77), respectively
A lack of follow-up data made it difficult to draw conclusions about long-term outcomes, our findings clearly indicate that EMS transportation can speed time to treatment, including time to balloon inflation, potentially reducing readmission and adverse events
Summary
The purpose of this multicenter study was to assess differences in demographics, medical history, treatment times, and follow-up status among patients with ST-elevation myocardial infarction (STEMI), who were transported to the hospital by emergency medical services (EMS) or by private vehicle, or were transferred from other medical facilities. Acute coronary syndrome (ACS) is a leading cause of morbidity and mortality worldwide,[1] with approximately half of these deaths occurring in the prehospital setting.[2] For patients presenting with ST-elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) is recommended.[3] The short- and long-term mortality of STEMI patients can be reduced with PCI and coronary artery bypass grafting (CABG),[4] with studies suggesting that primary PCI reduces mortality and major adverse cardiovascular events, when compared with thrombolytic therapy.[5,6] The updated 2015 guidelines of the American College of Cardiology/ American Heart Association (ACC/AHA) and the 2013 guidelines from the European Society of Cardiology recommend a door-to-balloon (D2B) time of less than 90 minutes.[6,7] When this goal is met, PCI for STEMI reduces mortality and morbidity.[8]. Advanced prehospital management by emergency medical services (EMS) plays a crucial role in facilitating access to care and reducing mortality rates for STEMI patients.[7,8,9,10,11] Studies have shown that transport by EMS is associated with quicker treatment, including shorter symptom-onset-to-arrival time and door-to-reperfusion time, when compared to private transport.[12,13] Several studies have found that among patients who underwent emergency angiography, D2B times were shorter in EMS-transported patients.[13,14,15]
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