Role of pre-hospital emergency medical systems in the rescue of patients with ST-elevation myocardial infarction

Abstract

BACKGROUND: Myocardial infarction (MI) is a series of clinical syndromes caused by ischemic necrosis of myocardial cells that results from severe and persistent acute ischemia of the myocardium due to a dramatic reduction or interruption of coronary blood supply. OBJECTIVE: In this study, we analyzed the role of pre-hospital emergency services in the rescue of patients suffering from ST-elevation myocardial infarction (STEMI). METHODS: We enrolled 229 patients with STEMI who were transported to the Second Hospital of Tianjin Medical University by Tianjin Emergency Center from January 2017 to June 2021. With the development of the pre-hospital emergency medical system in Tianjin (2019) as the time node, the patients were divided into three groups: A (87 cases), B (68 cases), and C (74 cases). The onset-to-call time, emergency response time, door-to-balloon (D-B) time, first medical contact to balloon dilation (FMC-B) time, symptom onset-to-balloon dilation (S-B) time, proportion of patients receiving prehospital administration of bispecific antibodies, number of days hospitalized, total hospitalization expenses, and in-hospital incidence and mortality of heart failure were compared between the three groups. RESULTS: Group C differed significantly from group A and group B in terms of emergency response time, D-B time, FMC-B time, S-B time, the proportion of patients who received prehospital administration of bispecific antibodies, and the number of days of hospitalization (P< 0.05), but there was no significant difference in the onset-to-call time (P> 0.05) and the decreasing trends in the in-hospital incidence and mortality of heart failure were not statistically significant (incidence: 9.50% vs. 13.23%, 12.64%; mortality: 4.10% vs. 5.90%, 4.60%). CONCLUSION: A reasonable pre-hospital emergency medical network layout and resource investment, as well as the strengthening of the interface between pre-hospital and in-hospital medical emergencies and pre-hospital standardized rescue, can shorten the emergency response time and the total ischemic time in patients with chest pain, which can improve patient prognosis to a certain extent.