Use of Emergency Medical Service Transport Among Patients With ST-Segment–Elevation Myocardial Infarction: Findings From the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry –Get With the Guidelines

Jun 28, 2011
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Authors:
Mathews R, Peterson ED, Li S, et al.
Citation:
Circulation 2011;Jun 20: [Epub ahead of print].
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What are the frequency, predictors, and clinical implications of emergency medical service (EMS) use in patients with ST-segment elevation myocardial infarction (STEMI)?

Methods:

The authors examined independent patient factors associated with EMS transportation versus patient self-transportation among 37,634 patients with STEMI treated at 372 US hospitals participating in the NCDR® ACTION Registry®–GWTG™ between January 2007 and September 2009.

Results:

EMS transport was used by 60% of STEMI patients. Older patients, those living farther from the hospital, and those with hemodynamic compromise were more likely to use EMS transport. In contrast, race, income, and education level did not appear to be associated with the mode of transport. Patients presenting via EMS were more likely to be in cardiogenic shock (8.9% vs. 2.7%) or exhibit symptoms of heart failure (14% vs. 8.3%). Compared with self-transported patients, EMS-transported patients had significantly shorter symptom-to-arrival time (median, 89 vs. 120 minutes; p < 0.0001) and door-to-reperfusion time (median door-to-balloon time, 63 vs. 76 minutes; p < 0.0001; median door-to-needle time, 23 vs. 29 minutes; p < 0.0001).

Conclusions:

The authors concluded that EMS use is associated with more rapid treatment of patients with STEMI, but remains underutilized in clinical practice.

Perspective:

Reducing symptom-to-door time in patients with STEMI has been a challenging problem, with most public education initiatives demonstrating either no impact or rapid attenuation of benefit. This study identifies EMS use as a key strategy that can reduce symptom-to-door time and ensure more rapid reperfusion. Further studies are needed to define strategies that would enhance EMS use by patients with chest pain.

Keywords: Shock, Cardiogenic, Registries, Myocardial Infarction, Transportation of Patients, Emergency Medical Services, Chest Pain, Heart Failure, Hemodynamics


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