Characteristics and In-Hospital Outcomes of Self-Transport Patients With Acute Myocardial Infarction　― A Nationwide Analysis ―

Background: Rapid access to emergency medical services (EMS) is essential to improve outcomes in patients with acute myocardial infarction (AMI). However, the outcomes of patients with AMI who are not transported by EMS remain unclear. Methods and Results: Patients who self-transported to hospital were classified into 2 groups according to Killip classification at the time of admission: those with heart failure (HF; Killip III or IV) and those without HF (Killip I or II). We assessed temporal trends in self-transport and compared patient characteristics and in-hospital mortality between the 2 groups. In all, 124,942 patients self-transported to hospital, of whom 18,342 (14.7%) were classified having HF. The proportion of patients self-transporting to hospital decreased from 35.3% in 2012 to 24.8% in 2023. Factors associated with self-transport with HF included older age (odds ratio [OR] 1.18; 95% confidence interval [CI] 1.17–1.20), female sex (OR 1.10; 95% CI 1.06–1.14), admission to non-training facilities (OR 1.49; 95% CI 1.29–1.73), and weekend admission (OR 1.09; 95% CI 1.04–1.13). In-hospital mortality was recorded for 2,599 (8.6%) and 1,265 (1.3%) self-transported patients with and without HF, respectively. Conclusions: Of self-transported patients with AMI, 14.7% had concomitant HF, highlighting a clinically non-negligible subgroup requiring careful attention.