Emergency procedural pathway combined with graded zoning management is associated with improved in-hospital survival and quality of life in patients with acute myocardial infarction.

BACKGROUND

Acute myocardial infarction (AMI) requires rapid emergency care; however, triage delays in high-volume emergency departments remain a persistent challenge. Evidence on the combination of emergency procedural pathways with graded zoning management in AMI care is limited.

METHODS

This prospective quasi-experimental study used sequential pre-post enrollment and included 126 patients with AMI. Patients admitted during the routine-care phase (CG; n = 64) received routine emergency nursing care, and patients admitted after protocol implementation (IG; n = 62) received an emergency procedural pathway combined with graded zoning management. Because enrollment was non-randomized and non-concurrent, all effect estimates were interpreted as associations rather than causal effects.

RESULTS

In-hospital survival was higher in the IG (96.8%, 60/62) than the CG [81.3%, 52/64; risk difference 15.5%, 95% CI 4.7-26.4%; p = 0.008; adjusted odds ratio [aOR] 6.50, 95% CI 1.32-32.0, p = 0.022]. First-aid time was shorter (67.30 ± 3.90 vs. 75.70 ± 4.50 min; mean difference -8.40, 95% CI -9.87 to -6.93; p < 0.001), and hospital stay reduced (14.62 ± 2.05 vs. 18.08 ± 4.55 days; mean difference -3.46, 95% CI -4.69 to -2.23; p < 0.001). Standardized reperfusion intervals were also shorter in the IG (door-to-balloon time among primary-PCI patients 78.5 ± 12.3 vs. 92.4 ± 15.6 min; door-to-needle time among thrombolysis patients 32.5 ± 6.8 vs. 41.2 ± 8.9 min; both p < 0.001). The cohort was predominantly STEMI (83.9% IG, 82.8% CG), with comparable reperfusion-modality use between groups. MACE was lower (6.5% vs. 18.8%; aOR 0.30, 95% CI 0.09-0.97, p = 0.045). Quality-of-life scores improved across all GQOL-74 domains (all p < 0.001); post-intervention SAS (31.70 ± 6.85 vs. 38.05 ± 7.24; p < 0.001) and SDS (34.10 ± 3.20 vs. 36.28 ± 3.18; p < 0.001) were lower in the IG. Patient satisfaction was higher (87.1% vs. 65.6%; risk difference 21.5%, 95% CI 7.4% to 35.6%; p = 0.005).

CONCLUSION

In this single-center quasi-experimental study, the emergency procedural pathway combined with graded zoning management was associated with higher in-hospital survival, shorter treatment-related time, fewer cardiovascular complications, and better discharge quality-of-life and satisfaction scores. The magnitude of the observed mortality difference should be interpreted cautiously because residual confounding from unmeasured AMI severity, reperfusion eligibility, and temporal changes cannot be excluded.