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 ≤30 min. We report DI–DO times and identify the main factors affecting them. RESURCOR is a French Northern Alps registry of patients with STEMI of <12 h 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 ≤30 min. 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.