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  • Is arrival by ambulance a risk factor for myocardial infarction in emergency department patients with cardiac sounding chest pain?

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Research letter
Is arrival by ambulance a risk factor for myocardial infarction in emergency department patients with cardiac sounding chest pain?
  1. James Murray1,
  2. Edwin Almaraj Raja2,
  3. Josip Plascevic1,
  4. Mark Jacunski3,
  5. Jamie G Cooper1,3
  1. 1 University of Aberdeen School of Medicine, Medical Sciences and Nutrition, Aberdeen, UK
  2. 2 Medical Statistics Team, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
  3. 3 Emergency Department, Aberdeen Royal Infirmary, Aberdeen, UK
  1. Correspondence to Dr Jamie G Cooper, Emergency Department, Aberdeen Royal Infirmary, Aberdeen, UK; jamie.cooper2{at}nhs.scot

https://doi.org/10.1136/emermed-2023-213643

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    Patients commonly present to the ED with cardiac sounding chest pain1 and a non-diagnostic ECG, yet an important proportion will be suffering from a myocardial infarction (MI) eligible for percutaneous coronary intervention.2 Age, male sex, hypertension, diabetes mellitus, hyperlipidaemia, ischaemic heart disease and smoking are all associated with an increased likelihood of an MI,2 but another potential predictor may be mode of ED arrival. Previous research from the USA found no association between ED arrival by ambulance and MI in patients with chest pain.3 In that study, 26% of patients with chest pain arrived by ambulance, but in the UK ambulances are freely accessible and often used to convey patients with chest pain to hospital.4 We determined whether ED arrival by ambulance was associated with the development of type 1 (acute atherosclerotic plaque rupture and thrombosis) or type 4b (in-stent thrombosis) or type 4c (in-stent restenosis) MI or cardiac death in a UK population.

    A retrospective analysis of adult (≥16 years) patients presenting to the ED of Aberdeen Royal Infirmary with chest pain suspicious for an MI and a non-diagnostic ECG was performed. Aberdeen Royal Infirmary is a tertiary referral hospital with approximately 60 000 adult ED attendances annually, and 36% of all patients arrived by ambulance in 2023. The study population comprised two cohorts: a …

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    Footnotes

    • Handling editor Darryl Wood

    • X @JamieCooperEM

    • Contributors JGC conceived the evaluation and its design. JM, JP and MJ acquired the data. JM and EAR performed the analysis and JM, EAR and JGC interpreted the data. JM and JGC drafted the manuscript. All authors reviewed the manuscript critically for intellectually important content and provided their final approval of the version to be submitted. All authors are accountable for the work and JGC is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.