Increase in self-presenting patients with ST-elevation myocardial infarction to the emergency department

Abstract

Background:

We provide data on self-presenting patients with a diagnosis of ST-elevation myocardial infarction (STEMI) from our local hospitals who were transferred to tertiary centres for primary percutaneous coronary intervention (PPCI).

Methodology:

An audit of self-presenting patients with STEMI who underwent PPCI from 1 April 2020 to 31 March 2023. Time variables and post-PPCI results were scrutinised.

Results:

A total of 126 patients were reviewed. There was a substantial increase in the number of self-presenting patients from 2020 to 2023 (23, 48 and 55, respectively, each year, p = 0.006). One hundred and one (80%) patients were men and 83 (66%) patients attended during out-of-hours. The median time from patients’ registration to having an ECG was 20 min [interquartile range (IQR) 12-38], from ECG to receiving dual anti-platelet was 29 min (IQR 18–52), from a referral made to the regional PPCI centre to when patients left emergency department (ED) was 55 min (IQR 32–79), and total time patients spent in the ED was 126 min (IQR 88–174). One hundred and eleven (88%) patients had PPCI, mostly single vessel and 4 (3%) patients died within 30 days of PPCI.

Conclusion:

There is an increasing trend in self-presentation with chest pain diagnosed as STEMI, with suboptimal guideline-directed timely management.