• Dae-Hyun Kim, Seok-Joo Moon, Juneyoung Lee, Jae-Kwan Cha, KimMoo HyunMHhttps://orcid.org/0000-0003-3468-6453Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea., Jong-Sung Park, Byeolnim Ban, Jihoon Kang, Beom Joon Kim, Won-Seok Kim, Chang-Hwan Yoon, Heeyoung Lee, Seongheon Kim, Eun Kyoung Kang, Ae-Young Her, Cindy W Yoon, Joung-Ho Rha, Seong-Ill Woo, Won Kyung Lee, Han-Young Jung, Jang Hoon Lee, Hun Sik Park, Yang-Ha Hwang, Keonyeop Kim, Rock Bum Kim, Nack-Cheon Choi, Jinyong Hwang, Hyun-Woong Park, Ki Soo Park, SangHak Yi, Jae Young Cho, Nam-Ho Kim, Kang-Ho Choi, Juhan Kim, Jae-Young Han, Jay Chol Choi, Song-Yi Kim, Joon-Hyouk Choi, Jei Kim, Min Kyun Sohn, Si Wan Choi, Dong-Ick Shin, Sang Yeub Lee, Jang-Whan Bae, Kun Sei Lee, and Hee-Joon Bae.
• Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea.
• J. Korean Med. Sci. 2022 Oct 31; 37 (42): e305.

BackgroundThere 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.MethodsUsing 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.ResultsAmong 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.ConclusionsVarious 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.© 2022 The Korean Academy of Medical Sciences.

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