Background: Good coronary care begins from the patient's home, including early transportation. As such, it is recommended that the patients activate ambulances, rather than to use their own transportations to reach the hospitals. It is not known whether Malaysian patients prefer to use private transportations or ambulances when they develop chest pain. Objectives: This study is conducted to explore the question of the choice of transportation modes among patients with acute coronary syndrome and the reasons behind their choices. Methods: This is a structured interview survey on patients diagnosed with acute coronary syndrome (ACS) in emergency department of Hospital Universiti Sains Malaysia from April 2012 to September 2012. Results: Out of the 110 patients surveyed, 105 (95.5%) patients chose to use own transportation when they developed symptoms suggestive of ACS. Only 3 patients (2.7%) came to the emergency department within 1 hour of onset, and all these 3 patients chose to use ambulances as their modes of transportation. None of the patients who chose own transportation came within the first hour of symptoms onset. This is shown to be statistically significant (p<0.001). The level of education as well as past history of ischemic heart disease did not significantly influence the patients’ choice of transportation. Conclusion: The admonishment by various international resuscitation councils that patients with chest pain should be transported via ambulances may not be as straightforward as it seems. Numerous local and regional socio-cultura and logistic factors may need to beaddressed.
Acute Coronary Syndrome ; Emergency Service, Hospital

Introduction: Patients with ST-segment elevation myocardial infarction (STEMI) often undergo percutaneous coronary intervention (PCI) procedures during their index hospitalisation. However, some factors may increase the risk of major adverse cardiac event (MACE) outcomes after delaying PCI. We aimed to determine the risk factors for MACE outcomes in acute STEMI patients who had PCI during their index admission. Methods: In this retrospective single-center study, the medical records of STEMI patients who had PCI during their index hospitalisation in our facility were retrieved. At 30 days and six months post-PCI, demographic characteristics, clinical presentation, coronary risk factors, and the rate of MACE outcome were recorded and analysed. Results: This study included 91 STEMI patients. At 30 days and six months post-PCI, the rate of MACE was 10.5% and 8.0% respectively. At 30 days post-PCI, gender (p = 0.025), systolic blood pressure (p = 0.005) and heart rate (p = 0.003) were all associated with MACE outcomes. At six months, systolic blood pressure (p = 0.017), heart rate (p = 0.003), and previous coronary artery disease (CAD) (p = 0.014) were all associated with MACE. Conclusion: In acute STEMI patients, female gender, systolic blood pressure, heart rate, and a history of CAD are the risk factors for MACE outcomes after the PCI during the index admission. However, this is only single center study with short follow up period. Therefore, multi centers study and longer follow up period could provide better understanding on the factors associated with delayed PCI.