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. 2020 Mar;109(3):393-399.
doi: 10.1007/s00392-019-01520-z. Epub 2019 Jun 29.

Predictors of transportation delay in patients with suspected ST-elevation-myocardial infarction in the VIENNA-STEMI network

Bernhard Jäger  1   2   3 , Paul Michael Haller  4 , Edita Piackova  4 , Alfred Kaff  5 , Günter Christ  6 , Wolfgang Schreiber  7 , Franz Weidinger  8 , Thomas Stefenelli  9 , Georg Delle-Karth  10 , Gerhard Maurer  11 , Kurt Huber  4   12 ; Vienna STEMI Registry Group
Affiliations

Predictors of transportation delay in patients with suspected ST-elevation-myocardial infarction in the VIENNA-STEMI network

Bernhard Jäger et al. Clin Res Cardiol. 2020 Mar.

Abstract

Objective: The emergency medical service (EMS) provides rapid pre-hospital diagnosis and transportation in ST-elevation myocardial infarction (STEMI) systems of care. Aim of the study was to assess temporal and regional characteristics of EMS-related delays in a metropolitan STEMI network.

Methods: Patient call-to-arrival of EMS at site (call-to-site), transportation time from site to hospital (site-to-door), call-to-door, patient's location, month, weekday, and hour of EMS activation were recorded in 4751 patients referred to a tertiary center with suspicion of STEMI.

Results: Median call-to-site, site-to-door, and call-to-door times were 9 (7-12), 39 (31-48), and 49 (41-59) minutes, respectively. The shortest transportation times were noted between 08:00 and 16:00 and in general on Sundays. They were significantly prolonged between midnight and 04:00, whereby the longest difference did not exceed 4 min in median. Patient's site of call had a major impact on transportation times, which were shorter in Central and Western districts as compared to Southern and Eastern districts of Vienna (p < 0.001 between-group difference for call-to-site, site-to-door, and call-to-door). After multivariable adjustment, patient's site of call was an independent predictor of call-to-site delay (p < 0.001). Moreover, age and hour of EMS activation were the strongest predictors of call-to-site, site-to-door, and call-to-door delays (p < 0.05).

Conclusion: In our Viennese STEMI network, the strongest determinants of pre-hospital EMS-related transportation delays were patient's site of call, patient's age, and hour of EMS activation. Due to the significant but small median time delays, which are within the guideline-recommended time intervals, no impact on clinical outcome can be expected.

Keywords: EMS; Emergency medical system; ST-elevation myocardial infarction; STEMI; System delay; Transportation delay.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Transportation times according to daytime, weekday, and month. Transportation times (minutes) are shown according to hour of the day (clusters of 4 h, upper row); weekday (middle row); and month (bottom row). Left column: patient call to ambulance arrival at site (call-to-site); mid column: ambulance arrival at site-to-door; right column: patient call-to-door. Call-to-site, site-to-door, and call-to-door were prolonged between 00:00 and 04:00 (p < 0.001); the shortest call-to-site, site-to-door, and call-to-door were on Sundays (call-to-site: p = 0.013, site-to-door: p < 0.001, call-to-door: p < 0.001). Month did not significantly impact transportation times (p > 0.05) (note: call-to-site for weekday and month is shown as mean rank (as median minutes are equal for each day and month, i.e., 9 min)
Fig. 2
Fig. 2
Call-to-site, site-to-door, and call-to-door in the 23 districts of Vienna. Districts are ranked and dyed according to detected transportation times. Dark shade depicts longer delay. Grey dots indicate the location of the six tertiary PCI units
See this image and copyright information in PMC

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