Impact of a New Referral System on Time to Treatment in Referred STEMI Patients Compared With Traditional Referral System at Maharat Nakhon Ratchasima Hospital

Abstract

Background: Acute ST-segment elevation myocardial infarction (STEMI) is an emergency condition with a high risk of death if not promptly treated with a reperfusion strategy. Delayed transfer of STEMI patients to the catheterization room is associated with poor outcomes and high mortality. The data recording and transmission system is an important factor that may help shorten the time to access treatment. Objective: To compare the time to reperfusion between 2 referral systems, the time-oriented transfer system with the traditional referral system. Methods: The retrospective study of confirmed STEMI patients within 2 distinct timeframes: May 1, 2019, to March 31, 2020, for the traditional referral system; and May 1, 2022, to March 31, 2023, for the time-oriented referral system. Patients between April 1, 2020, and April 30, 2022, were excluded due to the COVID-19 pandemic outbreak. Results: There were 330 (42.4%) patients referred through the traditional referral system, and 449 (57.6%) patients referred through the time-oriented referral system. Patients in both referral systems had comparable age and sex distributions. The Killip classification was also comparable. Patients in both referral systems were transferred from the community hospitals within comparable distance. The proportion of timely reperfusion was higher, and time to reperfusion were shorter than traditional referral system with statistically significant (median [IQR], 245 [160 - 340] and 203 [129 - 353] minutes, P < .05). Conclusions: The new referral system can reduce total ischemic and reperfusion time.