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Cardiovascular | Public Health & Policy

Acute myocardial infarction diagnosed in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022

Shin Ahn1orcid, Eunsil Ko2orcid, Young Sun Ro2,3orcid
Clinical and Experimental Emergency Medicine 2023;10(S):S42-S47.
Published online: November 8, 2023

1Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

2National Emergency Medical Center, National Medical Center, Seoul, Korea

3Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea

Correspondence to: Young Sun Ro Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, Korea Email: Ro.youngsun@gmail.com
• Received: October 4, 2023   • Accepted: October 18, 2023

Copyright © 2023 The Korean Society of Emergency Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

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Over the past decade, Korea has undergone significant transformations in its healthcare system, resulting in improved medical services, advanced technology, and enhanced public health initiatives [1–3]. In light of these developments, it is imperative to conduct a comprehensive analysis of the changing trends in acute myocardial infarction (AMI) presentations at emergency departments (EDs) across the nation. In this study, utilizing data from the National Emergency Department Information System (NEDIS), we aim to provide an overview of the current status of AMI diagnosed in EDs in Korea, including trends in incidence, demographic characteristics, and clinical outcomes categorized by age group and ED category. AMI diagnosis was confirmed using diagnostic codes I210–I219 during the 2018–2022 study period.
Ethics statement
This study was approved by the Institutional Review Board of the National Medical Center, Korea (No. NMC-2023-08-094). The requirement for informed consent was waived due to the retrospective nature of the study.
Fig. 1 illustrates the temporal trends in AMI incidence in Korea from 2018 to 2022. In the year 2018, the age and sex standardized incidence rate was 61.0 cases per 100,000 population, which steadily declined to 52.4 cases per 100,000 in 2022. Notably, men were three times more likely to be affected than women. As shown in Fig. 2, the in-hospital mortality rate for AMI in 2018 was 10.0% and remained relatively consistent throughout the study period, at 9.7% by 2022. Women consistently displayed a heightened vulnerability, experiencing 1.5 to 1.7 times greater mortality rates in comparison to men across the duration of the study. Fig. 3 illustrates that, of 100,000 ED visits in 2018, there were 35.5 AMI-related in-hospital mortalities. This pattern exhibited minor fluctuations, with 33.0 mortalities in 2022. Of 100,000 ED visits, AMI-related in-hospital mortalities were more pronounced among men, with a prevalence of 1.6 to 2.2 times higher than their female counterparts.
Table 1 shows that most AMI patients presenting to the ED were elderly (54.0%), followed by adults (45.9%), with an overall mean age of 66.2 years. Among these patients, men were 2.6 times more prevalent than women. The primary mode of transportation to the ED was ambulance (43.1%), followed by ambulatory (36.3%). This trend was consistent in both adult and elderly patient groups. However, for pediatric patients, the most common mode of transportation was ambulatory (69.9%). Most patients (69.8%) spent less than 6 hours in the ED, with a median duration of 196 minutes (interquartile range [IQR], 82–432 minutes). Elderly patients had the longest median length of ED stay at 229 minutes (IQR, 103–483 minutes). Of the total patients, approximately 90% were admitted, with 70% placed in intensive care units and the remaining 30% in general wards. In total, 1.9% of patients experienced death during their stay in the ED. Among these patients, the elderly population exhibited the highest mortality rate of 2.7%, which was higher than the rates of 1.2% for pediatric patients and 1.0% for adult patients with AMI. Considering the final disposition of these patients, elderly patients faced a markedly elevated death rate of 13.9%, in contrast to the 4.6% of the adult population and the 1.2% of the pediatric group. This disparity underscores the vulnerability of the elderly demographic when confronted with AMI and the subsequent challenges in managing their outcomes.
Table 2 presents the characteristics of AMI patients based on ED category. EDs in Korea are classified into three categories according to hospital function and size: level I, regional emergency medical centers; level II, local emergency medical centers; and level III, local emergency medical institutes. Study data reveal that most AMI patients visited level II EDs (55.9%), followed by level I (44.0%). Only a minority of patients chose to visit level III EDs (0.1%) for their initial place of care. The median time between the onset of symptoms and the presentation of patients to the ED was 133 minutes (IQR, 60–361 minutes) for the entire patient cohort. When examining specific types of EDs, patients visiting level II EDs had a median time of 120 minutes (IQR, 53–345 minutes), while those seeking care at level I EDs exhibited a median time of 152 minutes (IQR, 60–389 minutes). Direct presentation, without being transferred from other hospitals, was the most prevalent route of access to EDs (67.9%); level II (74.9%) and level III EDs (75.5%) had higher rates of direct visits compared to level I EDs (58.9%). Conversely, considering patients who were transferred from other hospitals, level I EDs had the largest proportion (38.8%). Admission rates for patients with AMI varied, with level I EDs having the highest admission rate (93.4%), followed by level II (86.3%) and level III EDs (78.3%). In contrast, the transfer rates to other hospitals were highest for patients initially presenting at level III EDs (20.8%), followed by level II (7.3%) and level I EDs (1.1%). A comparable pattern was evident in the final disposition of patients within each ED category. Specifically, 30.2% of patients visiting level III EDs were transferred to other medical institutions, as opposed to 12.3% in level II and 7.0% in level I EDs.
Interpreting the data presented in our study requires a comprehensive and nuanced understanding, and the characteristics inherent to each dataset must be considered. The included patients were those who presented to the ED within 24 hours of symptom onset and received a diagnosis of AMI either at the ED or upon inpatient discharge. However, recording of the time from symptom onset to hospital presentation is not mandatory in level III EDs, and the data may not have been consistently documented in these settings. Nevertheless, most cases of AMI diagnosed in EDs nationwide are likely to be included in the statistics, given that a significant number of patients diagnosed in level III EDs is subsequently transferred to specialized centers. The impact of the COVID-19 pandemic on AMI should be carefully considered. Reports indicate that the pandemic had both direct and indirect effects on AMI incidence and care. At the outset of the pandemic, many individuals exhibiting symptoms of a heart attack hesitated to seek medical attention due to concerns about contracting COVID-19 in healthcare settings. This reluctance led to delayed treatment-seeking, which may have resulted in more severe cases of AMI and poorer outcomes [4].. These observed trends could help explain the decreased incidence of AMI during the study period. Notably, the claims data obtained from the NEDIS, which is managed by the Ministry of Health and Welfare of Korea, is highly reliable. Several factors contribute to the reliability of this data. First, it benefits from the participation of a vast majority of EDs in the system, with more than 98% of them contributing data. Additionally, the dataset undergoes an annual review process conducted by the government, which further enhances its accuracy and quality [5–7]. When comparing the mortalities in the study dataset with those of others, it is important to take into account the differences in patient inclusion criteria. For instance, when examining data from the Korea Acute Myocardial Infarction Registry (KAMIR), the in-hospital mortality rate was 3.8% in 2018 and 5.7% in 2019 [8]. These results are derived from individuals admitted as inpatients within a select group of participating hospitals. However, the NEDIS dataset includes both fatalities from AMI that occurred in the ED and fatalities among individuals who were subsequently hospitalized following ED presentation. As a result, our dataset exhibits elevated in-hospital mortality rates. While these national data offer valuable insights into the characteristics of AMI patients visiting EDs in Korea, it also underscores some concerning trends. That more than one-third of patients arrive at EDs via non–ambulance vehicles suggests a potential lack of public awareness regarding the severity of AMI and the need for immediate medical attention. According to a report from the Korea Disease Control and Prevention Agency (KDCA) [9], the nationwide recognition rate of early symptoms of AMI in 2022 was 47.1%. This indicates that one of every two adults is unaware of early AMI symptoms. However, after initially being recorded at 46.5% in 2017, the recognition rate increased to 56.9% in 2019 but has been on a decline since 2020. Additionally, delayed hospital presentation among elderly patients, with a longer median time interval between symptom onset and ED arrival compared to adults shown in our data, is concerning, especially considering the higher mortality in this group compared to others. Early detection and prompt treatment of AMI are crucial in reducing mortality rates [10,11]. Therefore, it is vital to strengthen public health campaigns that raise awareness about the seriousness of AMI and the urgency of seeking medical assistance. Such efforts should also aim to reduce the time between symptom onset and ED arrival.

Author contributions

Conceptualization: all authors; Data curation: EK, YSR; Methodology: all authors; Project administration: YSR; Visualization: SA; Writing–original draft: SA, EK; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Conflicts of interest

The authors have no conflicts of interest to declare.

Funding

The authors did not receive any financial support for this study.

Data availability

Data of this study are from the National Emergency Medical Center (NEMC; Seoul, Korea) under the Ministry of Health and Welfare of Korea, which were used under license for the current study. Although the data are not publicly accessible, they are available from the corresponding author upon reasonable request with permission from the NEMC.

Fig. 1.
Age- and sex-standardized emergency department visit of acute myocardial infarction per 100,000 population.
ceem-23-140f1.jpg
Fig. 2.
In-hospital mortality rate of acute myocardial infarction.
ceem-23-140f2.jpg
Fig. 3.
Age- and sex-standardized mortality of acute myocardial infarction per 100,000 emergency department visits.
ceem-23-140f3.jpg
Table 1.
Characteristics of acute myocardial infarction according to age group
Table 1.
Characteristic Total Age group
Pediatric (0–17 yr) Adult (18–64 yr) Elderly (65–130 yr)
No. of patients 144,295 (100) 83 (0.1) 66,288 (45.9) 77,924 (54.0)
Age (yr) 66.2±13.8 12.3±4.5 53.8±7.8 76.8±7.6
Sex
 Male 104,072 (72.1) 60 (72.3) 57,815 (87.2) 46,197 (59.3)
 Female 40,223 (27.9) 23 (27.7) 8,473 (12.8) 31,727 (40.7)
Time between attack and presentationa) (median [IQR]) (min) 133 (60–361) 138 (57–429) 112 (51–295) 164 (60–426)
Route of arrival
 Direct visit 97,921 (67.9) 72 (86.7) 46,785 (70.6) 51,064 (65.5)
 Transferred from other hospital 42,640 (29.6) 10 (12.0) 17,889 (27.0) 24,741 (31.8)
 Referred from outpatient clinic 3,703 (2.6) 1 (1.2) 1,603 (2.4) 2,099 (2.7)
 Other 28 (0.0) 0 (0) 9 (0.0) 19 (0.0)
 Unknown 3 (0.0) 0 (0) 2 (0.0) 1 (0.0)
Transport
 119 Ambulance 62,180 (43.1) 17 (20.5) 27,342 (41.2) 34,821 (44.7)
 Other medical institution ambulance 6,862 (4.8) 5 (6.0) 2,572 (3.9) 4,285 (5.5)
 Other ambulance 21,711 (15.0) 3 (3.6) 8,464 (12.8) 13,244 (17.0)
 Police or official transport 112 (0.1) 0 (0) 78 (0.1) 34 (0.0)
 Air transport 784 (0.5) 0 (0) 370 (0.6) 414 (0.5)
 Ambulatory 52,358 (36.3) 58 (69.9) 27,341 (41.2) 24,959 (32.0)
 Other or unknown 288 (0.2) 0 (0) 121 (0.2) 167 (0.2)
Length of stay
 Mean±SD (min) 380.6±531.9 283.7±324.1 330.5±479.9 423.4±569.1
 Median (IQR) (min) 196 (82–432) 193 (134–291) 159 (65–369) 229 (103–483)
 0–6 hr 100,703 (69.8) 71 (85.5) 49,291 (74.4) 51,341 (65.9)
 6–12 hr 22,706 (15.7) 7 (8.4) 8,909 (13.4) 13,790 (17.7)
 12–24 hr 14,130 (9.8) 2 (2.4) 5,593 (8.4) 8,535 (11.0)
 ≥24 hr 6,751 (4.7) 3 (3.6) 2,492 (3.8) 4,256 (5.5)
 Unknown 5 (0.0) 0 (0) 3 (0.0) 2 (0.0)
ED disposition
 Discharge 5,782 (4.0) 33 (39.8) 2,687 (4.1) 3,062 (3.9)
 Admissionb) 129,019 (89.4) 40 (48.2) 60,032 (90.6) 68,947 (88.5)
  General wardc) 38,466 (29.8) 25 (62.5) 16,456 (27.4) 21,985 (31.9)
  Intensive care unitc) 90,506 (70.1) 15 (37.5) 43,560 (72.6) 46,931 (68.1)
 Transfer 6,650 (4.6) 9 (10.8) 2,869 (4.3) 3,772 (4.8)
 Hopeless discharge 19 (0.0) 0 (0) 0 (0) 19 (0.0)
 Death 2,779 (1.9) 1 (1.2) 668 (1.0) 2,110 (2.7)
 Other or unknown 46 (0.0) 0 (0) 32 (0.0) 14 (0.0)
Hospital disposition
 Discharge 114,996 (79.7) 73 (88.0) 58,088 (87.6) 56,835 (72.9)
 Transfer 14,413 (10.0) 9 (10.8) 4,767 (7.2) 9,637 (12.4)
 Hopeless discharge or transfer 127 (0.1) 0 (0) 28 (0.0) 99 (0.1)
 Death 13,886 (9.6) 1 (1.2) 3,022 (4.6) 10,863 (13.9)
 Other or unknown 873 (0.6) 0 (0) 383 (0.6) 490 (0.6)

Values are presented as number (%), unless otherwise indicated. Percentages may not total 100 due to rounding.

IQR, interquartile range; SD, standard deviation; ED, emergency department.

a)Data provided by emergency centers.

b)Data for the “other” category are not presented.

c)Proportion among total admissions.

Table 2.
Characteristics of acute myocardial infarction according to ED category
Table 2.
Characteristic Total Type of ED
Level I Level II Level III
No. of patients 144,295 (100) 63,463 (44.0) 80,726 (55.9) 106 (0.1)
Age (yr) 66.2±13.8 66.3±13.5 66.1±14.1 64.7±13.5
Sex
 Male 104,072 (72.1) 45,837 (72.2) 58,160 (72.0) 75 (70.8)
 Female 40,223 (27.9) 17,626 (27.8) 22,566 (28.0) 31 (29.2)
Time between attack and presentationa) (min) 133 (60–361) 152 (60–389) 120 (53–345) 122 (47–302)
Route of arrival
 Direct visit 97,921 (67.9) 37,374 (58.9) 60,467 (74.9) 80 (75.5)
 Transferred from other hospital 42,640 (29.6) 24,631 (38.8) 17,991 (22.3) 18 (17.0)
 Referred from outpatient clinic 3,703 (2.6) 1,449 (2.3) 2,246 (2.8) 8 (7.5)
 Other 28 (0.0) 8 (0.0) 20 (0.0) 0 (0)
 Unknown 3 (0.0) 1 (0.0) 2 (0.0) 0 (0)
Transport
 119 Ambulance 62,180 (43.1) 25,238 (39.8) 36,895 (45.7) 47 (44.3)
 Other medical institution ambulance 6,862 (4.8) 5,050 (8.0) 1,811 (2.2) 1 (0.9)
 Other ambulance 21,711 (15.0) 12,140 (19.1) 9,556 (11.8) 15 (14.2)
 Police or official transport 112 (0.1) 57 (0.1) 55 (0.1) 0 (0)
 Air transport 784 (0.5) 706 (1.1) 78 (0.1) 0 (0)
 Ambulatory 52,358 (36.3) 20,139 (31.7) 32,146 (39.8) 43 (40.6)
 Other or unknown 288 (0.2) 103 (0.2) 185 (0.2) 0 (0)
Length of stay
 Mean±SD (min) 380.6±531.9 452.2±586.7 324.6±477.3 185.8±259.8
 Median (IQR) (min) 196 (82–432) 250 (105–533) 163 (71–360) 96 (49–206)
 0–6 hr 100,703 (69.8) 40,078 (63.2) 60,536 (75.0) 89 (84.0)
 6–12 hr 22,706 (15.7) 11,690 (18.4) 11,002 (13.6) 14 (13.2)
 12–24 hr 14,130 (9.8) 7,717 (12.2) 6,411 (7.9) 2 (1.9)
 ≥24 hr 6,751 (4.7) 3,974 (6.3) 2,776 (3.4) 1 (0.9)
 Unknown 5 (0.0) 4 (0.0) 1 (0.0) 0 (0)
 ED disposition
 Discharge 5,782 (4.0) 2,219 (3.5) 3,562 (4.4) 1 (0.9)
 Admissionb) 129,019 (89.4) 59,297 (93.4) 69,639 (86.3) 83 (78.3)
  General wardc) 38,466 (29.8) 17,636 (29.7) 20,805 (29.9) 25 (30.1)
  Intensive care unitc) 90,506 (70.1) 41,641 (70.2) 48,807 (70.1) 58 (69.9)
 Transfer 6,650 (4.6) 716 (1.1) 5,912 (7.3) 22 (20.8)
 Hopeless discharge 19 (0.0) 11 (0.0) 8 (0.0) 0 (0)
 Death 2,779 (1.9) 1,203 (1.9) 1,576 (2.0) 0 (0)
 Other or unknown 46 (0.0) 17 (0.0) 29 (0.0) 0 (0)
Hospital disposition
 Discharge 114,996 (79.7) 52,654 (83.0) 62,276 (77.1) 66 (62.3)
 Transfer 14,413 (10.0) 4,428 (7.0) 9,953 (12.3) 32 (30.2)
 Hopeless discharge or transfer 127 (0.1) 95 (0.1) 32 (0.0) 0 (0)
 Death 13,886 (9.6) 5,978 (9.4) 7,901 (9.8) 7 (6.6)
 Other or unknown 873 (0.6) 308 (0.5) 564 (0.7) 1 (0.9)

Values are presented as number (%), unless otherwise indicated. Percentages may not total 100 due to rounding.

ED, emergency department; IQR, interquartile range; SD, standard deviation.

a)Data provided by emergency centers.

b)Data for the “other” category are not presented.

c)Proportion among total admissions.

  • 1. Lee JH, Lee DE, Ryoo HW, et al. Public awareness and willingness to use automated external defibrillators in a metropolitan city. Clin Exp Emerg Med 2021;8:1-8.
  • 2. Nah S, Han S, Park K, Kim C, Noh H, Eo E. Medical professionalism among emergency physicians in South Korea: a survey of perceptions and experiences of unprofessional behavior. Clin Exp Emerg Med 2022;9:54-62.
  • 3. Dongarwar D, Salihu HM. Implementation of universal health coverage by South Korea during the COVID-19 pandemic. Lancet Reg Health West Pac 2021;7:100093.
  • 4. Solomon MD, McNulty EJ, Rana JS, et al. The Covid-19 pandemic and the incidence of acute myocardial infarction. N Engl J Med 2020;383:691-3.
  • 5. Kim S, Kang H, Cho Y, et al. Emergency department utilization and risk factors for mortality in older patients: an analysis of Korean National Emergency Department Information System data. Clin Exp Emerg Med 2021;8:128-36.
  • 6. National Emergency Medical Center. 2021 Statistical yearbook of emergency medical service. National Emergency Medical Center of Korea; 2022.
  • 7. Pak YS, Ro YS, Kim SH, et al. Effects of emergency care-related health policies during the COVID-19 pandemic in Korea: a quasi-experimental study. J Korean Med Sci 2021;36:e121.
  • 8. Kim RB, Kim JR, Hwang JY. Epidemiology of myocardial infarction in Korea: hospitalization incidence, prevalence, and mortality. Epidemiol Health 2022;44:e2022057.
  • 9. Korea Disease Control and Prevention Agency (KDCA). Press release: how familiar are you with early symptoms of myocardial infarction? [Internet]. KDCA; 2023 [cited 2023 Oct 2]. Available from: https://www.kdca.go.kr/board/board.es?mid=a20501010000&bid=0015&act=view&list_no=723473
  • 10. Lefebvre C, Hoekstra J. Early detection and diagnosis of acute myocardial infarction: the potential for improved care with next-generation, user-friendly electrocardiographic body surface mapping. Am J Emerg Med 2007;25:1063-72.
  • 11. Katus H, Ziegler A, Ekinci O, et al. Early diagnosis of acute coronary syndrome. Eur Heart J 2017;38:3049-55.

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Acute myocardial infarction diagnosed in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
Clin Exp Emerg Med. 2023;10(S):S42-S47.   Published online November 8, 2023
DOI: https://doi.org/10.15441/ceem.23.140
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Acute myocardial infarction diagnosed in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
Clin Exp Emerg Med. 2023;10(S):S42-S47.   Published online November 8, 2023
DOI: https://doi.org/10.15441/ceem.23.140
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Acute myocardial infarction diagnosed in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
Image Image Image
Fig. 1. Age- and sex-standardized emergency department visit of acute myocardial infarction per 100,000 population.
Fig. 2. In-hospital mortality rate of acute myocardial infarction.
Fig. 3. Age- and sex-standardized mortality of acute myocardial infarction per 100,000 emergency department visits.

Fig. 1.

Fig. 2.

Fig. 3.

Acute myocardial infarction diagnosed in emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018–2022
Characteristic Total Age group
Pediatric (0–17 yr) Adult (18–64 yr) Elderly (65–130 yr)
No. of patients 144,295 (100) 83 (0.1) 66,288 (45.9) 77,924 (54.0)
Age (yr) 66.2±13.8 12.3±4.5 53.8±7.8 76.8±7.6
Sex
 Male 104,072 (72.1) 60 (72.3) 57,815 (87.2) 46,197 (59.3)
 Female 40,223 (27.9) 23 (27.7) 8,473 (12.8) 31,727 (40.7)
Time between attack and presentationa) (median [IQR]) (min) 133 (60–361) 138 (57–429) 112 (51–295) 164 (60–426)
Route of arrival
 Direct visit 97,921 (67.9) 72 (86.7) 46,785 (70.6) 51,064 (65.5)
 Transferred from other hospital 42,640 (29.6) 10 (12.0) 17,889 (27.0) 24,741 (31.8)
 Referred from outpatient clinic 3,703 (2.6) 1 (1.2) 1,603 (2.4) 2,099 (2.7)
 Other 28 (0.0) 0 (0) 9 (0.0) 19 (0.0)
 Unknown 3 (0.0) 0 (0) 2 (0.0) 1 (0.0)
Transport
 119 Ambulance 62,180 (43.1) 17 (20.5) 27,342 (41.2) 34,821 (44.7)
 Other medical institution ambulance 6,862 (4.8) 5 (6.0) 2,572 (3.9) 4,285 (5.5)
 Other ambulance 21,711 (15.0) 3 (3.6) 8,464 (12.8) 13,244 (17.0)
 Police or official transport 112 (0.1) 0 (0) 78 (0.1) 34 (0.0)
 Air transport 784 (0.5) 0 (0) 370 (0.6) 414 (0.5)
 Ambulatory 52,358 (36.3) 58 (69.9) 27,341 (41.2) 24,959 (32.0)
 Other or unknown 288 (0.2) 0 (0) 121 (0.2) 167 (0.2)
Length of stay
 Mean±SD (min) 380.6±531.9 283.7±324.1 330.5±479.9 423.4±569.1
 Median (IQR) (min) 196 (82–432) 193 (134–291) 159 (65–369) 229 (103–483)
 0–6 hr 100,703 (69.8) 71 (85.5) 49,291 (74.4) 51,341 (65.9)
 6–12 hr 22,706 (15.7) 7 (8.4) 8,909 (13.4) 13,790 (17.7)
 12–24 hr 14,130 (9.8) 2 (2.4) 5,593 (8.4) 8,535 (11.0)
 ≥24 hr 6,751 (4.7) 3 (3.6) 2,492 (3.8) 4,256 (5.5)
 Unknown 5 (0.0) 0 (0) 3 (0.0) 2 (0.0)
ED disposition
 Discharge 5,782 (4.0) 33 (39.8) 2,687 (4.1) 3,062 (3.9)
 Admissionb) 129,019 (89.4) 40 (48.2) 60,032 (90.6) 68,947 (88.5)
  General wardc) 38,466 (29.8) 25 (62.5) 16,456 (27.4) 21,985 (31.9)
  Intensive care unitc) 90,506 (70.1) 15 (37.5) 43,560 (72.6) 46,931 (68.1)
 Transfer 6,650 (4.6) 9 (10.8) 2,869 (4.3) 3,772 (4.8)
 Hopeless discharge 19 (0.0) 0 (0) 0 (0) 19 (0.0)
 Death 2,779 (1.9) 1 (1.2) 668 (1.0) 2,110 (2.7)
 Other or unknown 46 (0.0) 0 (0) 32 (0.0) 14 (0.0)
Hospital disposition
 Discharge 114,996 (79.7) 73 (88.0) 58,088 (87.6) 56,835 (72.9)
 Transfer 14,413 (10.0) 9 (10.8) 4,767 (7.2) 9,637 (12.4)
 Hopeless discharge or transfer 127 (0.1) 0 (0) 28 (0.0) 99 (0.1)
 Death 13,886 (9.6) 1 (1.2) 3,022 (4.6) 10,863 (13.9)
 Other or unknown 873 (0.6) 0 (0) 383 (0.6) 490 (0.6)
Characteristic Total Type of ED
Level I Level II Level III
No. of patients 144,295 (100) 63,463 (44.0) 80,726 (55.9) 106 (0.1)
Age (yr) 66.2±13.8 66.3±13.5 66.1±14.1 64.7±13.5
Sex
 Male 104,072 (72.1) 45,837 (72.2) 58,160 (72.0) 75 (70.8)
 Female 40,223 (27.9) 17,626 (27.8) 22,566 (28.0) 31 (29.2)
Time between attack and presentationa) (min) 133 (60–361) 152 (60–389) 120 (53–345) 122 (47–302)
Route of arrival
 Direct visit 97,921 (67.9) 37,374 (58.9) 60,467 (74.9) 80 (75.5)
 Transferred from other hospital 42,640 (29.6) 24,631 (38.8) 17,991 (22.3) 18 (17.0)
 Referred from outpatient clinic 3,703 (2.6) 1,449 (2.3) 2,246 (2.8) 8 (7.5)
 Other 28 (0.0) 8 (0.0) 20 (0.0) 0 (0)
 Unknown 3 (0.0) 1 (0.0) 2 (0.0) 0 (0)
Transport
 119 Ambulance 62,180 (43.1) 25,238 (39.8) 36,895 (45.7) 47 (44.3)
 Other medical institution ambulance 6,862 (4.8) 5,050 (8.0) 1,811 (2.2) 1 (0.9)
 Other ambulance 21,711 (15.0) 12,140 (19.1) 9,556 (11.8) 15 (14.2)
 Police or official transport 112 (0.1) 57 (0.1) 55 (0.1) 0 (0)
 Air transport 784 (0.5) 706 (1.1) 78 (0.1) 0 (0)
 Ambulatory 52,358 (36.3) 20,139 (31.7) 32,146 (39.8) 43 (40.6)
 Other or unknown 288 (0.2) 103 (0.2) 185 (0.2) 0 (0)
Length of stay
 Mean±SD (min) 380.6±531.9 452.2±586.7 324.6±477.3 185.8±259.8
 Median (IQR) (min) 196 (82–432) 250 (105–533) 163 (71–360) 96 (49–206)
 0–6 hr 100,703 (69.8) 40,078 (63.2) 60,536 (75.0) 89 (84.0)
 6–12 hr 22,706 (15.7) 11,690 (18.4) 11,002 (13.6) 14 (13.2)
 12–24 hr 14,130 (9.8) 7,717 (12.2) 6,411 (7.9) 2 (1.9)
 ≥24 hr 6,751 (4.7) 3,974 (6.3) 2,776 (3.4) 1 (0.9)
 Unknown 5 (0.0) 4 (0.0) 1 (0.0) 0 (0)
 ED disposition
 Discharge 5,782 (4.0) 2,219 (3.5) 3,562 (4.4) 1 (0.9)
 Admissionb) 129,019 (89.4) 59,297 (93.4) 69,639 (86.3) 83 (78.3)
  General wardc) 38,466 (29.8) 17,636 (29.7) 20,805 (29.9) 25 (30.1)
  Intensive care unitc) 90,506 (70.1) 41,641 (70.2) 48,807 (70.1) 58 (69.9)
 Transfer 6,650 (4.6) 716 (1.1) 5,912 (7.3) 22 (20.8)
 Hopeless discharge 19 (0.0) 11 (0.0) 8 (0.0) 0 (0)
 Death 2,779 (1.9) 1,203 (1.9) 1,576 (2.0) 0 (0)
 Other or unknown 46 (0.0) 17 (0.0) 29 (0.0) 0 (0)
Hospital disposition
 Discharge 114,996 (79.7) 52,654 (83.0) 62,276 (77.1) 66 (62.3)
 Transfer 14,413 (10.0) 4,428 (7.0) 9,953 (12.3) 32 (30.2)
 Hopeless discharge or transfer 127 (0.1) 95 (0.1) 32 (0.0) 0 (0)
 Death 13,886 (9.6) 5,978 (9.4) 7,901 (9.8) 7 (6.6)
 Other or unknown 873 (0.6) 308 (0.5) 564 (0.7) 1 (0.9)
Table 1. Characteristics of acute myocardial infarction according to age group

Values are presented as number (%), unless otherwise indicated. Percentages may not total 100 due to rounding.

IQR, interquartile range; SD, standard deviation; ED, emergency department.

Data provided by emergency centers.

Data for the “other” category are not presented.

Proportion among total admissions.

Table 2. Characteristics of acute myocardial infarction according to ED category

Values are presented as number (%), unless otherwise indicated. Percentages may not total 100 due to rounding.

ED, emergency department; IQR, interquartile range; SD, standard deviation.

Data provided by emergency centers.

Data for the “other” category are not presented.

Proportion among total admissions.

Table 1.

Table 2.

CEEM : Clinical and Experimental Emergency Medicine

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