SPC365

Is a fast pathway the best way to enter?

Session: Sessão de Posters 46 - Síndromes coronárias agudas: vias, atrasos e impacto das recomendações
Speaker: Luis Miguel de Sousa Azevedo

Congress: CPC 2026
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Luís Sousa Azevedo; Isabel Martins Moreira; Isabel Nóbrega Fernandes; Pedro Sousa Mateus; Sílvia Leão; Ilidio Moreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Admission protocols such as Acute Coronary Syndrome (ACS) fast-track pathways are designed to accelerate treatment in patients with ST-elevation myocardial infarction (STEMI), with the aim of improving clinical outcomes.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Objective</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We aimed to evaluate whether the mode of admission of STEMI patients, within the context of current protocols implemented in our centre, has an impact on long-term outcomes.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">This retrospective observational study included patients admitted to our centre with STEMI between October 2010 and July 2025, all of whom were recorded in a national registry. Other forms of ACS were excluded. Patients were categorized into three groups according to their mode of admission: transfer from another hospital, admission through the Emergency Department (ED), and admission through the ACS Fast-Track pathway. Differences between groups were assessed using the chi-square test for categorical variables and median comparison tests for continuous variables. To evaluate the impact of admission route on outcomes, we performed a multivariate binary logistic regression for the composite endpoint of all-cause mortality or cardiovascular readmission during the first year after discharge. In this analysis, admission through the ACS Fast-Track pathway was used as the reference category.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">A total of 695 patients were included, of whom 520 (74.8%) were male, with a median age of 66 years. Of these, 305 patients (43.9%) were transferred from other hospitals, 203 (29.2%) were admitted via the ACS Fast-Track pathway, and the remaining 187 (26.9%) presented to the ED. No significant baseline differences were observed between groups (table 1 and 2). In the multivariate logistic regression for the composite endpoint, no significant differences were found between admission routes (p = 0.466). Neither transfer from another hospital (OR = 0.913; 95% CI 0.513&ndash;1.626; p = 0.757) nor ED admission (OR = 9.725; 95% CI 0.218&ndash;433.409; p = 0.240) differed significantly from ACS Fast-Track admissions (table 3).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">In this study, the mode of admission was not associated with differences in the composite endpoint of all-cause mortality or cardiovascular readmission during the first year. This may indicate that delays inherent to certain admission routes are compensated by system-level factors&mdash;such as pre-activation of the catheterization laboratory for transferred patients, ensuring immediate intervention upon arrival, and rapid recognition of STEMI in the ED. Notably, only 29.2% of patients were admitted through the ACS fast-track pathway, whereas 70.8% arrived at the hospital (our center or a non-PCI capable hospital) by their own means. This observation points to potential limitations in health literacy within our population, leading to inadequate recognition of ACS symptoms and failure to seek appropriate emergency care.</span></span></p>

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