STEMI patients' demographics and outcomes by mode of emergency department arrival

The aim of this study was to identify the demographic factors influencing the mode of emergency department (ED) admission among patients with ST-elevation myocardial infarction (STEMI), comparing those arriving by emergency medical services (EMS) versus walk-in patients, and to correlate them with outcomes.

This retrospective observational study utilized data provided by the regional emergency agency (AREU), analyzing ED admissions for STEMI across 120 hospitals in Lombardy between 1 January 2022 and 31 December 2022. The prevalence of EMS use and of walk-in patients was determined and the association between the mode of ED access and patient outcomes was assessed.

We recorded 8235 STEMI cases, of which 58.4% presented at the ED via EMS. Younger and male patients were more likely to use self-transport. Age was positively correlated with EMS use, especially in cases with a red triage code. Patients accessing the ED independently were more likely to require secondary transport [odds ratio (OR) 3.80, 95% confidence interval (CI) 3.17-4.51; P < 0.001]. One hundred and twenty-eight deaths were recorded, of which 96 (75%) occurred in patients over 75 years of age. Women were more likely to die than men (OR 2.16, 95% CI 1.52-3.02; P < 0.001).

The number of patients not using EMS highlights the need for public education on the importance of EMS as a means of transport and as a platform for early treatment. Public health campaigns should focus on raising awareness of gender differences in the presentation of STEMI and address treatment disparities to improve outcomes for all patient groups.