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KMID : 0191120220370420305
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Journal of Korean Medical Science
2022 Volume.37 No. 42 p.305 ~ p.305
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Comparison of Factors Associated With Direct Versus Transferred-in Admission to Government-Designated Regional Centers Between Acute Ischemic Stroke and Myocardial Infarction in Korea
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Kim Dae-Hyun
Moon Seok-Joo
Lee June-Young
Cha Jae-Kwan
Kim Moo-Hyun
Park Jong-Sung
Ban Byeol-Nim
Kang Ji-Hoon
Kim Beom-Joon
Kim Won-Seok
Yoon Chang-Hwan
Lee Hee-Young
Kim Seong-Heon
Kang Eun-Kyoung
Her Ae-Young
Yoon Cindy W.
Rha Joung-Ho
Woo Seong-Ill
Lee Won-Kyung
Jung Han-Young
Lee Jang-Hoon
Park Hun-Sik
Hwang Yang-Ha
Kim Keon-Yeop
Kim Rock-Bum
Choi Nack-Cheon
Hwang Jin-Yong
Park Hyun-Woong
Park Ki-Soo
Yi Sang-Hak
Cho Jae-Young
Kim Nam-Ho
Choi Kang-Ho
Kim Ju-Han
Han Jae-Young
Choi Jay-Chol
Kim Song-Yi
Choi Joon-Hyouk
Kim Jei
Sohn Min-Kyun
Choi Si-Wan
Shin Dong-Ick
Lee Sang-Yeub
Bae Jang-Whan
Lee Kun-Sei
Bae Hee-Joon
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Abstract
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Background: There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI.
Methods: Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed.
Results: Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI; additionally, age (65?74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI.
Conclusions: Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.
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KEYWORD
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Acute Ischemic Stroke, Myocardial Infarction, Transferred-in, Cardiocerebrovascular Center
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