Abstract 79: Emergency Medical Services Utilization in ST-Elevation Myocardial Infarction: Significant Urban Versus Rural Differences
Background: National practice guidelines and strategies for reperfusion recommend pre-hospital ambulance triage of STEMI patients en route to PCI hospitals. Unfortunately, Emergency Medical Services (EMS) have been underutilized which could limit this strategy and cause treatment delays.
Objective: To assess the prevalence of EMS use by ST-segment myocardial infarction (STEMI) patients and its impact on door to balloon times in a regional STEMI network.
Methods: Data were obtained from a prospective registry of 1,464 consecutive STEMI patients admitted or transferred to a regional PCI center.
Results: EMS use by STEMI patients was stratified by gender, age and rural vs urban (table⇓). Only 40% of rural STEMI patients utilize EMS versus 65% of urban patients. In the urban setting there were no significant age group (p=0.50) or gender (p=0.64) differences. In contrast, in the rural setting, males (p<0.0001) and age <65 (p<0.0001) are less likely to use EMS. Median door to balloon times were shorter for those using EMS in both urban (60 vs 77 minutes: p<0.0001) and rural settings (103 vs 107 minutes, p=0.006).
Conclusion: In contrast to patients in the urban setting, significant gender and age differences are present in rural EMS utilization. Door to balloon times are faster when STEMI patients use EMS in both settings, but less time is saved in rural patients. These findings may impact current reperfusion strategies and should direct public educational efforts towards those subgroups who are least likely to use EMS in the event of an acute myocardial infarction.