Use of emergency medical service in acute myocardial infarction in an Italian Northeastern region

This study aimed at assessing emergency medical service (EMS) use by patients with acute myocardial infarction (AMI), factors associated with EMS use, and outcomes in the 1,200,000-inhabitant Italian region of Friuli Venezia Giulia. Anonymous health administrative databases were analyzed from 2010 to 2019. EMS use was assessed from Emergency Department and hospital discharge data for patients discharged with main diagnosis of AMI (ICD-9-CM 410.×1). Factors associated with EMS, likelihood of undergoing a primary percutaneous coronary intervention (pPCI) and of 30-day mortality were assessed in univariate and multivariate analyses. In 10 years, 14,900 AMI patients were hospitalized. Only half used EMS, with no changes over time. Demographic and residential factors and comorbidities affected EMS use. Although patients transported by EMS had increased 30-day mortality, undergoing pPCI decreased mortality significantly (in STEMI, OR 0.41). In this region, patients transported by EMS had increased mortality, probably because of residual confounding due to AMI severity; however, undergoing pPCI halved mortality. EMS use has not increased over time and was not uniform across the region. This finding emphasizes the need of population campaigns covering all the regional geographic areas. The importance of transporting patients by EMS directly to PCI facilities should be stressed.