Impact of different admission ways on treatment efficiency in patients with acute ST-segment elevation myocardial infarction / 中华心血管病杂志

ABSTRACT

Objective: To analyze the impact of different admission ways on the timeliness of percutaneous coronary intervention and in-hospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: A total of 1 044 patients with STEMI, who received primary percutaneous coronary intervention (PPCI) in 9 hospitals in Chengdu from January 2017 to June 2019, were retrospectively enrolled. According to the admission ways, patients were divided into ambulance group (n=100), self-transport group (n=584) and transferred group (n=360). Timeliness and in-hospital mortality were compared among the groups. Indicators of timeliness included the time from symptoms onset to arrive at the hospital, the time from arrive at the hospital to balloon and the total myocardial ischemia time (the time from symptoms to balloon). Multivariate logistic regression analysis was used to verify whether the admission ways was the determinant for in-hospital death in STEMI patients receiving PPCI. Results: The median total myocardial ischemic time in the ambulance group was significantly shorter than that in the self-transport group (180.0 (135.0, 282.0) minutes vs. 278.0 (177.8, 478.5) minutes, P<0.05) and the transferred group (180.0 (135.0, 282.0) minutes vs. 301.0 (204.3, 520.8) minutes, P<0.05). The median time from symptoms to door was as follows ambulance group<self-transport group<transferred group (100.0 (56.3, 198.0) minutes vs. 149.0 (72.0, 313.5) minutes vs. 238.0 (135.0, 545.0) minutes, all P<0.05). The median door-to-balloon time was significantly shorter in the ambulance group and transferred group than in the self-transport group (75.0 (44.3, 101.8) minutes vs. 97.0 (71.0, 140.5) minutes, 67.0 (40.0, 91.8) minutes vs. 97.0 (71.0, 140.5) minutes, both P<0.05). There was no significant difference in all-cause mortality among the three groups (P>0.05). Multivariate logistic regression analysis showed that admission way was not significantly associated with in-hospital death (P>0.05). Conclusions: STEMI patients, who are admitted through the medical emergency system, are more likely to receive timely interventional therapy.Different admission ways have no impact on in-hospital mortality.