Door-in to door-out times in acute ST-segment elevation myocardial infarction in emergency departments of non-interventional hospitals A cohort study

In France, one in eight patients with acute ST-segment elevation myocardial infarction (STEMI) is admitted direct to an emergency department (ED) in a hospital without percutaneous coronary intervention (PCI) facilities. Guidelines recommend transfer to a PCI center, with a door-in to door-out (DI-DO) time of <= 30min. We report DI-DO times and identify the main factors affecting them. RESURCOR is a French Northern Alps registry of patients with STEMI of <12h duration. We focused on patients admitted direct, without prehospital medical care, to EDs in 19 non-PCI centers from 2012 to 2014. We divided DI-DO time into diagnostic time (ED admission to call for transfer) and logistical time (call for transfer to ED discharge). Among 2007 patients, 240 were admitted direct to EDs in non-PCI centers; 57.9% were treated with primary angioplasty and 32.9% received thrombolysis. Median (interquartile range) DI-DO time was 92.5 (67-143) min, with a diagnostic time of 41 (23-74) min and a logistical time of 47.5 (32-69) min. Five patients (2.1%) had a DI-DO time <= 30min. Five variables were independently associated with a shorter DI-DO time: local transfer (mobile intensive care unit [MICU] team available at referring ED) (P=.017) or transfer by air ambulance (P=.004); shorter distance from referring ED to PCI center (P<.001); shorter time from symptom onset to ED admission (P=.002); thrombolysis (P=.006); and extended myocardial infarction (P=.007). In view of longer-than-recommended DI-DO times, efforts are required to promote urgent local transfer and use of thrombolysis.