The Impact of Transportation Mode on ST-Segment Elevation Myocardial Infarction (STEMI) Reperfusion Time and Survival

TL;DR

This study shows that patients arriving by emergency medical services have faster treatment times and better outcomes for heart attacks compared to those who self-transport.

Contribution

The study provides empirical evidence on how transportation mode affects reperfusion times and survival in STEMI patients.

Findings

Patients arriving via EMS had significantly shorter door-to-ECG and door-to-balloon times compared to self-transport patients.

The EMS group had a higher incidence of cardiopulmonary resuscitation upon arrival, indicating more critical initial conditions.

Abstract

Background: Acute coronary syndrome continues to be the leading cause of mortality worldwide, making it crucial to achieve a door-to-balloon (D2B) time under 90 minutes to enhance patient outcomes. This study aims to evaluate how outcomes differ between patients who arrive via emergency medical services (EMS) and those who arrive via self-transport.

Methods: This was a retrospective study conducted at a tertiary hospital in the eastern province of Saudi Arabia. The study included both Saudi and non-Saudi patients who presented to the emergency department (ED) between March 1, 2022, and November 11, 2024, with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) requiring primary percutaneous coronary intervention (PCI). Patients were divided into two groups based on their mode of transport. Collected data include age, gender, nationality, D2B and door-to-electrocardiogram (ECG) times, smoking status, chronic conditions, and peak troponin levels.

Results: A total of 204 STEMI and NSTEMI infarction cases were included in this study. Most cases (172, 84.3%) arrived via self-transport, while 32 (15.7%) arrived via EMS. The EMS group demonstrated significantly shorter median times for both door-to-ECG time (3 minutes vs. 5.5 minutes; p<0.05) and D2B time (70 minutes vs. 87 minutes; p<0.05) compared to the self-transport group. In addition, the EMS group had a higher incidence of cardiopulmonary resuscitation (CPR), indicating that their initial presentation is likely to be critical.

Conclusion: Our findings are consistent with existing literature, highlighting the role of EMS in reducing door-to-ECG and D2B times. The higher frequency of CPR in EMS-transported patients indicates the severity of their condition upon arrival, further emphasizing the importance of prehospital emergency care in optimizing outcomes.

Figures