Comparison of treatment delays and in-hospital outcomes between self-transported and EMS-transported patients with ST-segment elevation myocardial infarction undergoing PCI

Abstract

The effectiveness of reperfusion therapy in patients with myocardial infarction (MI) depends largely on timely treatment. This study aimed to compare treatment delays and in-hospital outcomes between self-transported and EMS-transported patients with STEMI. This retrospective observational cohort study included 208 patients with AMI who underwent PCI between March 2022 and June 2023. Of these, 92 patients arrived at the hospital by self-transport and 116 were transported by EMS. A p-value < 0.05 was considered statistically significant. The study population was predominantly male (78.4%), with a mean age of 58.05 ± 12.06 years. Significant differences were observed between self-transported and EMS-transported patients in onset-to-door time ( P < 0.001) and door-to-balloon time ( P = 0.001). However, no significant differences were found in AMI-related complications, including stroke, cardiogenic shock, heart failure, pericarditis, and dysrhythmias. Likewise, in-hospital outcomes, including left ventricular ejection fraction, length of hospital stay, hospitalization costs, and mortality, did not differ significantly between the two groups. Although EMS transport was associated with acceptably shorter treatment delays in patients with STEMI, total treatment times remained longer than recommended guideline targets. Our findings suggest that improving EMS utilization alone may be insufficient to improve clinical outcomes when overall system delays remain prolonged. However, given the limited sample size and low event rates, the results should be interpreted with caution. Patient-related factors may also influence treatment outcomes. Future large-scale studies are warranted to identify modifiable factors associated with treatment delays throughout the STEMI care pathway and to determine whether addressing these factors improves clinical outcomes.