J Korean Soc Emerg Med.  2020 Apr;31(2):181-190.

Comparison of major cardiac and cerebrovascular events in patients withacute myocardial infarction according to the use of emergency medical serviceduring one-year clinical follow-up

• Kim SJ
• Lee ES
• Jeong MH
• Kim MC
• Sim DS
• Hong YJ
• Kim JH
• Ahn Y
• Cho MC
• Kim CJ
• Kim YJ

Abstract

Objective
The emergency medical service (EMS) is expected to improve the prognosis of patients suffering from acute myocardial infarction (AMI). We investigated the impact of utilizing EMS on the clinical outcomes of AMI patients.
Methods
From November 2011 to November 2015, a total of 13,102 patients in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) registry were enrolled. Patients were divided into two groups: the EMS group, first medical contact (FMC) with 119; the non-EMS group, the FMC at local hospitals that were not available for percutaneous coronary intervention. The authors analyzed the mortality and major adverse cardiac and cerebrovascular events during one-year of clinical follow-up.
Results
A total of 8,863 patients were finally analyzed for this study, and a total of 1,999 patients (22.6%) utilized the EMS as FMC. The patients utilizing EMS were more frequently diagnosed with ST-segment elevation AMI. At presentation, the EMS group had a higher incidence of Killip class IV, and they had a shorter symptom-to-door time than non- EMS group. The patients utilizing EMS had higher incidence of peri-procedural complications and in-hospital mortality. The multivariate logistic regression analysis with backward elimination revealed that utilizing EMS is an independent factor for predicting lower one-year mortality.
Conclusion
This study has demonstrated that the high-risk AMI patients can utilize the EMS in Korea. The EMS group has more favorable clinical outcome during one-year follow-up after discharge than the non-EMS group, whereas it had a higher rate of death during hospitalization compared with that of the non-EMS group.

Keyword

Emergency medical service; Myocardial infarction; Mortality