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Association between prehospital recognition of acute myocardial infarction and length of stay in the emergency department.

Objectives
This study aimed to evaluate the association between prehospital recognition of acute myocardial infarction (AMI) and length of stay in the emergency department (ED LOS) of emergency medical service (EMS)-transported AMI patients.


Methods
A multicenter retrospective observational study was conducted using prehospital and hospital data from three tertiary emergency departments. Patients diagnosed with AMI between January 2015 and December 2018 were enrolled. Study groups were categorized according to prehospital recognition and prehospital 12-lead electrocardiography (ECG) into three groups based on an EMS cardiovascular registry: Group A, no prehospital recognition (reference group); Group B, prehospital recognition without 12-lead ECG; and Group C, prehospital recognition with 12-lead ECG. The primary outcome was an ED LOS of less than 4 hours.


Results
Among 1,237 study participants, 722 (58.4%) were in Group A, 325 (26.3%) were in Group B, and 190 (15.4%) were in Group C. Multivariable logistic regression showed that Groups B and C had a higher likelihood of a short ED LOS (adjusted odds ratio (95% confidence interval): Group B, 1.64 (1.21-2.22) and Group C, 1.88 (1.30-2.71)) than Group A. There was no significant difference in ED LOS according to whether prehospital 12-lead ECG was conducted.


Conclusions
Prehospital recognition of AMI by EMS personnel, with or without 12-lead ECG, was associated with a short ED LOS.