title: Mode of admission and its effect on adherence to reperfusion therapy guidelines in Belgian STEMI patients.
abstract: OBJECTIVE
  Emergency medical services play a key role in the recognition and treatment of ST-segment elevation myocardial infarction (STEMI). This study evaluates the effect of emergency medical services use on adherence to reperfusion therapy guidelines in Belgian STEMI patients and on in-hospital mortality.
  
  
  METHODS
  The mode of admission with against without emergency medical services was associated with baseline risk profile, reperfusion modalities and in-hospital mortality in 5692 consecutive STEMI patients from 2012 to 2014.
  
  
  RESULTS
  A total of 3896 STEMI patients (68%) were transported to the hospital by emergency medical services, and 1796 patients (32%) arrived at the hospital using their own transport (self-referral). Emergency medical services patients were older than self-referral patients (64 vs. 62 years) and more frequently presented with cardiac arrest (14% vs. 5%) and with cardiogenic shock (10% vs. 4%). Emergency medical services patients received primary percutaneous coronary intervention more often (95% vs. 91%, P<0.0001) and more frequently within 90 minutes (72% vs. 65%, P<0.001). Moreover, the time interval between symptom onset and reperfusion therapy was shorter in the emergency medical services group (median of 195 vs. 255 minutes, P<0.001). Crude in-hospital mortality was higher in the emergency medical services group (7.7% vs. 3.8%, P<0.0001) and was mainly driven by the high prevalence of cardiogenic shock and cardiac arrest in the emergency medical services group. After adjustment, the impact on mortality was no longer significantly different.
  
  
  CONCLUSIONS
  Emergency medical services are used by two-thirds of Belgian STEMI patients and are associated with a better adherence to STEMI reperfusion guidelines. These data favour the use of emergency medical services as the preferred transfer system for patients with chest pain suspicious for STEMI.
authors.affiliation: Hôpital Molière et Ixelles, Emergency Department, Brussels, Belgium.
authors.forename: Céline
authors.initials: C
authors.lastname: Rousseaux
authors.affiliation: CHU Saint-Pierre, Emergency Department, Belgium ULB Brussels, Department of Cardiology, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mols
authors.affiliation: UZ Leuven, Department of Cardiology, Belgium.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Sinnaeve
authors.affiliation: ZNA Antwerpen, Department of Cardiology, Belgium.
authors.forename: Carl
authors.initials: C
authors.lastname: Convens
authors.affiliation: CHU Charleroi, Department of Cardiology, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Dubois
authors.affiliation: Virga Jesse Hasselt, Department of Cardiology, Belgium.
authors.forename: Pascal
authors.initials: P
authors.lastname: Vranckx
authors.affiliation: UZ Gent, Department of Cardiology, Belgium.
authors.forename: Sofie
authors.initials: S
authors.lastname: Gevaert
authors.affiliation: AZ Brugge, Department of Cardiology, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Coussement
authors.affiliation: CHU Saint-Pierre, Emergency Department, Belgium.
authors.forename: Ahmed Se
authors.initials: AS
authors.lastname: Ramadan
authors.affiliation: UCL Louvain, Department of Cardiology, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Beauloye
authors.affiliation: ULB Brussels, Department of Cardiology, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Renard
authors.affiliation: UCL Mont-Godinne, Department of Intensive Care, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Evrard
authors.affiliation: UZ Brussels, Department of Cardiology, Belgium.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Argacha
authors.affiliation: OLV Aalst, Department of Cardiology, Belgium.
authors.forename: Herbert
authors.initials: H
authors.lastname: De Raedt
authors.affiliation: University Hospital Antwerp, Department of Statistics, Belgium.
authors.forename: Kristien
authors.initials: K
authors.lastname: Wouters
authors.affiliation: University Hospital Antwerp, Department of Cardiology, Belgium marc.claeys@uantwerpen.be.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Claeys
mesh_terms: D000368:Aged; D001530:Belgium / Q000453:epidemiology; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality* / Q000628:therapy*
keywords: Emergency medical services; STEMI; reperfusion therapy