Impact of transport pathways on the time from symptom onset of ST-segment elevation myocardial infarction to door of coronary intervention facility

• Published in: Journal of Cardiology Vol. 64; no. 1; pp. 11 - 18
• Main Authors: Fujii, Toshiharu, Masuda, Naoki, Suzuki, Toshihiko, Trii, Sho, Murakami, Tsutomu, Nakano, Masataka, Nakazawa, Gaku, Shinozaki, Norihiko, Matsukage, Takashi, Ogata, Nobuhiko, Yoshimachi, Fuminobu, Ikari, Yuji
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.07.2014; Elsevier BV
• Subjects: Aged; Aged, 80 and over; Cardiology and Cardiovascular Medicine; Cardiovascular; Coronary artery disease; Death, Sudden, Cardiac; Death, Sudden, Cardiac - prevention & control; Electrocardiography; Emergency care; Fatal cardiology; Female; Health Facilities; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Percutaneous Coronary Intervention; Prognosis; Retrospective Studies; Time Factors; Transportation of Patients; Transportation of Patients - methods; Treatment; Myocardial infarction; Emergency care; Treatment; Coronary artery disease; Fatal cardiology
• ISSN: 0914-5087; 1876-4738; 1876-4738
• DOI: 10.1016/j.jjcc.2013.11.008

Reducing total ischemic time is important in achieving better outcome in ST-segment elevation myocardial infarction (STEMI). Although the onset-to-door (OTD) time accounts for a large portion of the total ischemic time, factors affecting prolongation of the OTD time are not established. The purpose of this study was to determine the impact of transport pathways on OTD time in patients with STEMI. We retrospectively studied 416 STEMI patients who were divided into 4 groups according to their transport pathways; Group 1 (n=41): self-transportation to percutaneous coronary intervention (PCI) facility; Group 2 (n=215): emergency medical service (EMS) transportation to PCI facility; Group 3 (n=103): self-transportation to non-PCI facility; and Group 4 (n=57): EMS transportation to non-PCI facility. OTD time was compared among the 4 groups. Median OTD time for all groups combined was 113 (63–228.8)min [Group 1, 145 (70–256.5); Group 2, 71 (49–108); Group 3, 260 (142–433); and Group 4, 184 (130–256)min]. OTD time for EMS users (Groups 2 and 4) was 138min shorter than non-EMS users (Groups 1 and 3). Inter-hospital transportation (Groups 3 and 4) prolonged OTD by a median of 132min compared with direct transportation to PCI facility (Groups 1 and 2). Older age, history of myocardial infarction, prior PCI, shock at onset, high Killip classification, and high GRACE Risk Score were significantly more frequent in EMS users. Self-transportation without EMS and inter-hospital transportation were significant factors causing prolongation of the OTD time. Approximately 35% of STEMI patients did not use EMS and 21% of patients were transported to non-PCI facilities even though they called EMS. Awareness in the community as well as among medical professionals to reduce total ischemic time of STEMI is necessary; this involves educating the general public and EMS crews.