Impact Of Different Admission Patterns In Time Delays And Prognosis Of Patients With ST-segment Elevation Myocardial Infarction

Objectives: To compare the characteristics,reperfusion times delays and prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)in different ways of admission and to explore the further improvement of care and process for STEMI.Methods: A total of 293 STEMI patients undergoing primary percutaneous coronary intervention(PCI)were enrolled between December 2016 to March 2018.Patients were divided into 120 groups(n=66),self-transfer group(n=111) and referral group(n=116) according to the way of admission.Median follow-up time was 310-day.Baseline data,angiographic and procedure data,reperfusion time delays and adverse cardiac and cerebral vascular events(MACCE)were collected and compared among the three groups.Multivariable logistic model was used to assess the relationship of symptom-to-first medical contact time ?90 min with different admission patterns.Impact factors of MACCE were analyzed by Cox regression analysis.Results: Except for age and hypertension there were no significant differences of baseline characteristics,angiographic and procedural characteristics among three groups.Pre-hospital electrocardiogram transmission and direct admission to cath-lab were more frequently occurred in patients referred from non-PCI hospitals compared to 120 group(51.5% versus 76.7%,16.7% versus 76.7%,all P<0.001).Compared to 120 group and self-transfer group,referral group had the longest first medical contact-to-balloon time(80 min versus 126 min,67 min versus 126 min) and the shortest door-to-balloon time(56 min versus 34 min,64 min versus 34 min)(adjusted P<0.001).The 120 group had the shortest symptom-to-balloon time(132 min versus 237 min,132 min versus 241 min) and symptom-to-first medical contact time(46 min versus 133 min,46 min versus 100 min) of the three groups(adjusted P<0.001).The association between the admission patterns and symptom-to-first medical contact time <90 min were statistically significant after multivariate adjustment(P<0.001).In-hospital outcome was not influenced by the different admission ways.Symptom-to-first medical contact time ?90 min is an independent risk factor for MACCE(HR 1.823,95% CI 1.005–3.307,P=0.048).Conclusion: Calling 120 timely after onset,transmitting pre-hospital electrocardiogram,and bypassing emergency departments are the optimal practices to reduce reperfusion time and improve prognosis of patients with STEMI.