European Heart Journal: Acute Cardiovascular Care 2016, Vol. 5(5) 461–467 © The European Society of Cardiology 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2048872616647708 acc.sagepub.com EUROPEAN SOCIETY OF CARDIOLOGY ® Mode of admission and its effect on adherence to reperfusion therapy guidelines in Belgian STEMI patients Céline Rousseaux 1 , Pierre Mols 2,3 , Peter R Sinnaeve 4 , Carl Convens 5 , Philippe Dubois 6 , Pascal Vranckx 7 , Sofie Gevaert 8 , Patrick Coussement 9 , Ahmed SE Ramadan 2 , Christophe Beauloye 10 , Marc Renard 3 , Patrick Evrard 11 , Jean-François Argacha 12 , Herbert De Raedt 13 , Kristien Wouters 14 and Marc J Claeys 15 Abstract Objectives: Emergency medical services play a key role in the recognition and treatment of ST-segment elevation myocardial infarction (STEMI). This study evaluates the effect of emergency medical services use on adherence to reperfusion therapy guidelines in Belgian STEMI patients and on in-hospital mortality. Methods: The mode of admission with against without emergency medical services was associated with baseline risk profile, reperfusion modalities and in-hospital mortality in 5692 consecutive STEMI patients from 2012 to 2014. Results: A total of 3896 STEMI patients (68%) were transported to the hospital by emergency medical services, and 1796 patients (32%) arrived at the hospital using their own transport (self-referral). Emergency medical services patients were older than self-referral patients (64 vs. 62 years) and more frequently presented with cardiac arrest (14% vs. 5%) and with cardiogenic shock (10% vs. 4%). Emergency medical services patients received primary percutaneous coronary intervention more often (95% vs. 91%, P<0.0001) and more frequently within 90 minutes (72% vs. 65%, P<0.001). Moreover, the time interval between symptom onset and reperfusion therapy was shorter in the emergency medical services group (median of 195 vs. 255 minutes, P<0.001). Crude in-hospital mortality was higher in the emergency medical services group (7.7% vs. 3.8%, P<0.0001) and was mainly driven by the high prevalence of cardiogenic shock and cardiac arrest in the emergency medical services group. After adjustment, the impact on mortality was no longer significantly different. Conclusion: Emergency medical services are used by two-thirds of Belgian STEMI patients and are associated with a better adherence to STEMI reperfusion guidelines. These data favour the use of emergency medical services as the preferred transfer system for patients with chest pain suspicious for STEMI. Keywords Emergency medical services, STEMI, reperfusion therapy Date received: 14 August 2015; accepted: 29 March 2016 1 Hôpital Molière et Ixelles, Emergency Department, Brussels, Belgium 2 CHU Saint-Pierre, Emergency Department, Belgium 3 ULB Brussels, Department of Cardiology, Belgium 4 UZ Leuven, Department of Cardiology, Belgium 5 ZNA Antwerpen, Department of Cardiology, Belgium 6 CHU Charleroi, Department of Cardiology, Belgium 7 Virga Jesse Hasselt, Department of Cardiology, Belgium 8 UZ Gent, Department of Cardiology, Belgium 9 AZ Brugge, Department of Cardiology, Belgium 10 UCL Louvain, Department of Cardiology, Belgium 647708ACC 0 0 10.1177/2048872616647708European Heart Journal: Acute Cardiovascular CareRousseaux et al. research-article 2016 Original scientific paper 11 UCL Mont-Godinne, Department of Intensive Care, Belgium 12 UZ Brussels, Department of Cardiology, Belgium 13 OLV Aalst, Department of Cardiology, Belgium 14 University Hospital Antwerp, Department of Statistics, Belgium 15 University Hospital Antwerp, Department of Cardiology, Belgium Corresponding author: Marc J Claeys, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium. Email: marc.claeys@uantwerpen.be Downloaded from https://academic.oup.com/ehjacc/article/5/5/461/5922222 by guest on 13 December 2022