Impact of Transport Method in Patients With ST-Segment-Elevation Myocardial Infarction on Patient Outcomes: Real-World Data From the ACSIS Registry

Background: The ambulance system is vital for the early management of patients with ST-segment-elevation myocardial infarction, reducing delays in diagnosis and treatment. This study examined the impact of transport mode on reperfusion therapy and mortality among patients with ST-segment-elevation myocardial infarction from 2000 to 2021. Methods: Data from the ACSIS (Acute Coronary Syndrome Israeli Survey) registry 2000 to 2021 were analyzed. Three transport methods of patients with ST-segment-elevation myocardial infarction were evaluated. The impact on patient outcomes was assessed. Temporal trends from early (2000-2010) and late (2013-2021) periods were compared. Results: Of 8035 patients with ST-segment-elevation myocardial infarction, 52.9% were transported by mobile intensive care units, 13.1% by basic life support ambulances, and 34% self-transported. Use of mobile intensive care units increased from 48.7% to 60.9% (P<0.001), while self-transport decreased from 36.8% to 28.7% (P<0.001). Time from hospital arrival to primary percutaneous coronary intervention significantly decreased for mobile intensive care unit patients (60 to 36 minutes; P<0.001) and for basic life support patients (90 to 73 minutes; P=0.002), while self-transport showed no significant change. Adjusted analysis revealed a decrease in 30-day major adverse cardiovascular events (odds ratio, 0.53; P<0.001) and 1-year mortality rates (hazard ratio, 0.84; P<0.05) for the entire cohort with no difference within or upon comparing transport methods between periods. Primary percutaneous coronary intervention rates and guideline-directed medical therapy also rose significantly (P<0.001). Conclusions: Improved major adverse cardiovascular event and mortality rates are attributed to enhanced in-hospital and postdischarge care, including primary percutaneous coronary intervention and guideline-directed medical therapy rather than transport improvements, although these contribute to more stable arrival conditions.