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Poor transportation increased onset-to-door times in STEMI
Self-transportation or transportation to a non-PCI facility by emergency services were factors associated with increased onset-to-door times in a cohort of individuals with STEMI, according to recent findings.
The researchers suggested that there is uncertainty surrounding factors associated with onset-to-door times, which accounts for a large part of the total ischemic time, and sought to determine the impact of transport pathways on onset-to-door times in a cohort of 416 patients with STEMI.
The four transportation groups were as follows: 41 patients in group 1 found their own transportation to a PCI facility; 215 patients in group 2 used emergency medical service transportation to a PCI facility; 103 patients in group 3 found their own transportation to a non-PCI facility; and 57 patients in group 4 received emergency transportation to a non-PCI facility.
The overall median onset-to-door time was 113 minutes (63-228.8 minutes). For group 1, the time was 145 minutes (70-256.5), whereas the time was 71 minutes (49-108) for group 2, 260 minutes (142-433) for group 3 and 184 minutes (130-256) for group 4.
Results indicated onset-to-door times were 138 minutes shorter among individuals who used emergency transportation (groups 2 and 4) compared with those who provided their own transportation (groups 1 and 3).
Transportation between hospitals, which occurred in groups 3 and 4, yielded increases in onset-to-door times by a median of 132 compared with those who received direct transportation to a PCI facility (groups 1 and 2), according to the results.
Patients in the emergency transportation group were more likely to be older, and have shock at onset, a history of MI or PCI, and high Killip classification and GRACE risk scores.
Other results indicated that 35% of patients with STEMI did not use emergency medical services and 21% called emergency services but were not taken to a PCI facility.
“Awareness in the community as well as among medical professionals to reduce total ischemic time of STEMI is necessary,” the researchers concluded. “This involves educating the general public and [emergency medical service] crews.”
Disclosure: The researchers report no relevant financial disclosures.