Key result
EMS transport linked to ~17 minutes shorter D2B time versus self-transport for primary PCI.
Why the study?
Achieving a door-to-balloon time under 90 minutes is crucial to enhance outcomes in ACS, prompting an evaluation of how outcomes differ between patients arriving via EMS versus self-transport.
Does arrival via emergency medical services (EMS) reduce door-to-balloon and door-to-ECG times in patients with STEMI and NSTEMI requiring primary PCI compared to self-transport?
Observational (n=204)
No
Does arrival via emergency medical services (EMS) reduce door-to-balloon and door-to-ECG times in patients with STEMI and NSTEMI requiring primary PCI compared to self-transport?
Absolute Event Rate: 70% vs 87%
p-value: p=0.018
EMS transport for patients with myocardial infarction requiring primary PCI significantly reduces door-to-ECG and door-to-balloon times compared to self-transport, highlighting the critical role of prehospital emergency care.
Supports EMS activation in suspected MI; leaves open effects on clinical outcomes.
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.
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Aljaili et al. (2026) conducted an observational in ST-segment elevation myocardial infarction (STEMI) and NSTEMI requiring primary percutaneous coronary intervention (n=204). Emergency medical services (EMS) transport vs. Self-transport was evaluated on Median door-to-balloon (D2B) time in minutes (p=0.018). Emergency medical services transport significantly reduced median door-to-balloon time to 70 minutes compared to 87 minutes for self-transported patients requiring primary PCI.
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