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Increase in self-presenting patients with ST-elevation myocardial infarction to the emergency department

Ronald Manorekang1, Alison Eales1, James Thomas1

  • 1Cardiology Department, Calderdale Royal Hospital, Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK.

The Journal of the Royal College of Physicians of Edinburgh
|May 19, 2025
PubMed

Insights

The number of patients with ST-elevation myocardial infarction (STEMI) self-presenting for care is increasing. Current management shows delays in timely treatment, indicating a need for improved guideline adherence.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Public Health

Background:

  • STEMI patients often self-present to local hospitals before transfer for primary percutaneous coronary intervention (PPCI).
  • Data on the trends and outcomes of these self-presenting STEMI patients are crucial for optimizing care pathways.

Purpose of the Study:

  • To analyze the trend of self-presenting STEMI patients over a three-year period.
  • To evaluate the timeliness of care and outcomes for STEMI patients undergoing PPCI.

Main Methods:

  • Retrospective audit of self-presenting STEMI patients undergoing PPCI between April 2020 and March 2023.
  • Analysis of time intervals from registration to ECG, treatment, and emergency department discharge.
  • Review of post-PPCI outcomes, including mortality.

Main Results:

  • A significant increase in self-presenting STEMI patients was observed from 2020 to 2023 (p=0.006).
  • Most patients were male (80%) and attended out-of-hours (66%).
  • Median times included: registration to ECG (20 min), ECG to dual anti-platelet (29 min), referral to ED departure (55 min), and total ED time (126 min). 88% received PPCI, with 3% 30-day mortality.

Conclusions:

  • There is a growing trend of self-presentation for STEMI.
  • Current management pathways for these patients demonstrate suboptimal adherence to guideline-directed timelines.
  • Further improvements in emergency care coordination are needed to ensure timely reperfusion therapy.
Abstract

Keywords:
ACSSTEMIambulancecall to balloonchest paindoor to balloonemergency medicinemyocardial infarctionparamedicself-presenting patient

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