Patients with acute myocardial infarction using ambulance or private transport to reach definitive care: which mode is quicker?

Abstract

One of the main reasons cited by patients with acute myocardial infarction (AMI) for not using an ambulance was quickness of private transport. To examine differences in transport times for patients with AMI who used ambulance compared with patients who used private transportation to reach definitive care in Beijing. Data were prospectively collected from the 498 patients with ST-elevation myocardial infarction admitted within 12 h of symptom onset to 19 hospitals in Beijing between 1 November 2005 and 31 December 2006. Elapsed time to definitive care was examined through the use of (i) decision to seek care to hospital arrival (private transport group) versus emergency medical service (EMS) arrival on scene (ambulance transport group), (ii) decision to seek care to hospital arrival, (iii) decision to seek care to reperfusion therapy and (iv) symptom onset to reperfusion therapy for both groups. Private transportation resulted in faster hospital arrival than using ambulance (median, 35 vs 50 min, P < 0.001). However, if one considers EMS treatment to be initial definitive care, using ambulance resulted in much quicker care than patients using private transportation to the hospital (median, 15 vs 35 min, P < 0.001). In addition, using ambulance resulted in shorter decision-to-balloon (173 vs 193 min, P = 0.049) and symptom onset-to-balloon (medians, 223 vs 300 min, P < 0.001) times compared with patients using private transportation. Although private transportation results in a faster trip to the hospital, quicker definitive care is obtained with the use of ambulance.