Abstract 13823: Use of Emergency Medical Services Expedites In-Hospital Care Processes in Patients Presenting With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Objective: To evaluate whether door-to-balloon (DTB) times of patients presenting with ST-segment elevation myocardial infarction (STEMI) are reduced in patients transported by emergency medical services (EMS) compared to patients who are self transported.
Background: DTB is an important measure of hospital care process in STEMI. Use of EMS transport may expedite in-hospital processing and reduce DTB times.
Methods: A total of 309 consecutive STEMI patients who presented to our institution and who underwent primary percutaneous coronary intervention were analyzed. Excluded were patients who received fibrinolytics, presented in cardiac arrest, were intubated, or transferred from another hospital. Patients transported by EMS (n=83) were compared to self transported patients (n=226).
Results: A higher percentage of EMS transported patients reached the time goal of DTB <90 minutes compared to self transported patients (83.1 vs 54.3%; p <0.001). EMS transported patients had shorter DTB times [median (IQR) minutes, 65 (50-86) vs 85 (61-126); p <0.001] due to a reduction of emergency department processing (door-to-call) time, whereas catheterization laboratory processing (call-to-balloon) times were similar in both groups. (Figure) EMS-transported patients had shorter symptom-to-door [median (IQR) hours, 1.2 (0.8-3.5) vs 2.3 (1.2-7.5); p <0.001] and symptom-to-balloon hours [median (IQR) , 2.5 (1.9-4.7) vs 4.3 (2.6-9.1); p <0.001]. Independent correlates of DTB times >90 minutes were self transport (OR 5.32, 95% CI 2.65-10.70; p <0.001) and off-hours presentation (OR 2.89, 95% CI 1.60-5.22; p <0.001).
Conclusion: Use of EMS transport in STEMI patients significantly shortens time to reperfusion, primarily by expediting emergency department processes. Community education efforts should focus not only on the importance of recognizing symptoms of myocardial infarction, but also on taking early action by calling EMS.
- © 2013 by American Heart Association, Inc.