Key result
D-Cath system linked to ~21-minute shorter diagnosis-to-cath time vs conventional referral in STEMI.
Why the study?
The clinical impact of the Direct Admission System for STEMI patients to the catheterization laboratory (D-Cath) compared to standard management was unclear.
Does the D-Cath direct admission system reduce treatment delays and improve outcomes in STEMI patients compared to conventional referral?
Cohort (n=166)
Yes
Does the D-Cath direct admission system reduce treatment delays and improve outcomes in STEMI patients compared to conventional referral?
Absolute Event Rate: 30% vs 51%
p-value: p=<0.001
Direct prehospital admission to the catheterization laboratory for STEMI significantly reduces system delays in an urban EMS network, supporting guidelines for rapid reperfusion strategies.
May accelerate STEMI cath lab access in EMS systems; leaves open effects on mortality and need for randomized trials.
Objective: To compare treatment timelines, diagnostic concordance, and short-term mortality between ST-elevation myocardial infarction (STEMI) patients transferred via the D-Cath system and those managed without the system. Materials and Methods: A prospective descriptive cohort study was conducted among STEMI patients diagnosed in the prehospital setting by the Bangkok EMS system. Patients were divided into the D-Cath group (83 patients) and the non-D-Cath group (83 patients). Descriptive and inferential statistics were applied using an intention-to-treat analysis. Results: Baseline characteristics were similar between groups. The D-Cath group had a significantly shorter diagnosis-to-catheterization laboratory (cath lab) time compared with the non-D-Cath group (30.0 vs. 51.0 minutes, p<0.001). However, the proportion of patients who reached the cath lab within 90 minutes was similar between groups (68.7% vs. 67.5%, p=1.000). When using a stricter benchmark of ≤60 minutes, a significantly higher proportion of patients in the D-Cath group met this target (62.7% vs. 50.6%, p=0.022). The diagnosis-to-wire crossing time was also shorter in the D-Cath group (87.0 vs. 106.0 minutes, p=0.045). While the proportion of patients achieving wire crossing within 120 minutes did not differ significantly between groups (59.0% vs. 50.6%, p=0.125), a significantly higher proportion of patients in the D-Cath group achieved wire crossing within 90 minutes (42.2% vs. 21.7%, p=0.002). Diagnostic concordance between prehospital and in-hospital physicians was 70.5%, and 48-hour mortality did not differ significantly between groups (12.0% vs. 15.7%, p=0.500). Conclusion: The D-Cath system significantly reduced both diagnosis-to-cath lab and diagnosis-to-wire crossing times. However, the relatively low diagnostic concordance raises concerns regarding the efficiency of resource utilization. Further studies with larger sample sizes are needed to better determine the overall clinical benefit of this system.
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Pitiyakulchorn et al. (2026) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=166). Direct Admission System to Catheterization Laboratory (D-Cath) vs. Conventional referral (non-D-Cath) was evaluated on Diagnosis-to-catheterization laboratory (cath lab) time (p=<0.001). The D-Cath system significantly reduced median diagnosis-to-cath lab time (30.0 vs 51.0 minutes, p<0.001) compared to conventional referral in STEMI patients.
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