Comparison of clinical indicators of patients with acute myocardial infarction undergoing primary angioplasty admitted to the Madani Hospital in Tabriz by code 247( Pre-hospital notification) and personal referral.

Abstract

Abstract

Background: STEMI is one of the most critical medical emergencies and a leading cause of mortality in modern societies. Enhancing knowledge and care quality for this condition is essential. Timely primary angioplasty is one of the most effective treatments to reopen blocked vessels and restore blood flow to ischemic heart tissue. In Iran, the national Code 247 program addresses STEMI management. This study aimed to compare the clinical indicators of STEMI patients treated with primary angioplasty admitted via Code 247 and personal referral methods. Materials and Methods: This descriptive-comparative study included 313 STEMI patients treated with primary angioplasty at the emergency department of Madani Hospital in Tabriz in 2023. Participants were selected based on inclusion criteria using a available sampling method. Data collection involved a demographic form and clinical indicators. The form's face and content validity were reviewed by 15 experts. Reliability was assessed using the inter-rater agreement method, yielding a Cohen’s kappa of 0.86 and an inter-class correlation coefficient of 0.92. Serum troponin measurement and echocardiography calibration adhered to protocol. Data analysis was conducted using SPSS version 23 with descriptive statistics (frequency, median, quartiles) and inferential tests (Mann-Whitney U, Chi-square, Kruskal-Wallis). Regression analysis, including linear, multiple, and logistic regression, was applied to control confounders. Results: The majority of patients were male (78.3%) and urban residents (76.4%), with about 50% aged 60 years or younger. Median prehospital delay and time to primary angioplasty were 191 and 302 minutes, respectively—exceeding recommended standards. Door-to-wire time averaged 80 minutes, within the standard limit. Admission via Code 247 was statistically significantly lower than personal referral (P < 0.001). Patients admitted via Code 247 demonstrated better clinical outcomes, including lower serum troponin I levels, higher left ventricular ejection fraction, and greater angioplasty success rates (P < 0.001). Conclusion: The study highlights significant prehospital delays in STEMI management. Early angioplasty is particularly recommended for rural and remote patients through the Code 247 system. Enhanced training for the general public, managers, and emergency personnel on the national STEMI management program is crucial to improve coordination and outcomes.