Impact of emergency services and ambulance type on pain-to-balloon time in the acute myocardial infarction: an observational study

Objective: The objective of this study was to evaluate the role of first contact emergency departments and ambulances on transport duration, pain-to-balloon time, door-to-balloon time and first contact-to-balloon time in acute myocardial infarction (AMI) patients. Methods: The study was a prospective and observational investigation. A total of 374 AMI patients initially admitted to primary coronary intervention (PCI) incapable centers were included in this study. Patients were classified according to initial presentation site (daily clinic, public hospital or private hospital) and transport manner (public or private ambulance). All groups were compared by the Kruskal-Wallis and Mann- Whitney U tests statistically according to their characteristics, transport duration and pain-to-balloon time. Results: A majority of the patients were initially admitted to public (40.1%) or private hospitals (47.1%). The average door-to-balloon time was 45.0±18.5 min and the mean pain-to-balloon time was 310.6±160.8 min. Nearly half of the patients initially admitted to daily clinics were first transported to PCI-incapable centers, leading to delayed admission to PCI-capable centers and increased pain-to-balloon and first contact-to- balloon times (361.7±194.5 min, p=0.01 and 279.7±158.2 min, p 0.001). Patients admitted to private hospitals experienced shorter average pain- to-balloon and first contact-to-balloon times (277.5±148.6 min, p=0.01 and 157.4±83.1 min, p 0.001). Patients transported by private ambulances also experienced shorter waiting times and shorter pain-to-balloon times (107.4±70.4 and 270.1±150.4 min, p 0.001). Conclusion: Physicians and healthcare professionals in first contact emergency departments and ambulance type appear to be factors in the increased pain-to-balloon time. AMI patients are often initially admitted to PCI-incapable centers, leading to delayed admission to PCI-capable centers and increased pain-to-balloon time.