Objective To review the impact on outcomes of direct admission versus emergency room (ER) admission in patients with ST‐segment elevation myocardial infarction (STEMI) Design Nationwide observational registry of STEMI patients Setting 369 rigorous care devices in France. enrolled 66.9% were admitted direct and 33.1% via the ER. Bypassing the ER was associated with more frequent use of reperfusion (61.7% 53.1%; p??=??0.001) and shorter delays between sign onset and admission (244 (interquartile range 158) 292 (172)?min; p?TSPAN3 the 1st 24?h the use of PCI was similar in both organizations. Slightly more individuals underwent coronary artery bypass grafting (CABG) among those who were admitted via the ER compared with those admitted direct. Figure 1?Use of reperfusion therapy according to admission pathway. CCU coronary care unit; PCI percutaneous coronary treatment. Table 2?Delays from sign Pralatrexate onset to admission and from sign onset to reperfusion therapy Results At five days all‐cause mortality was 4.9% in patients admitted direct to the CCU compared with 8.6% (p??=??0.01) in those admitted via the ER. By multivariable analysis (?(tablestables 3 and 4?4 fig 2?2) ) admission via the ER was an independent correlate of five day time mortality when adjusting for the simplified TIMI risk score (OR 1.67 95 CI 1.01 to 2.75) (fig 2?2).). Subset Pralatrexate analyses found that the benefit of bypassing the ER on modified five day time mortality was consistent across sex and was observed regardless of whether or not the individuals had been treated in mobile intensive care devices (fig 2?2).). There was a non‐significant tendency for a greater good thing about bypassing the ER in those individuals with delays to therapy >?3?h as opposed to ??3?h after sign onset. Number 2?Indie predictors of five day time mortality for individuals admitted via the emergency room compared to those admitted direct for the whole population and across determined subgroups adjusting for the simplified TIMI risk score. MICU mobile … Table 3?All‐cause mortality at day time 5 with adjusted odds ratios Table 4?All‐cause mortality at one year with adjusted risk ratios One Pralatrexate year follow‐up data were obtained in 91% of individuals (99% had one month follow‐up available and 94% had six month follow‐up available). One year all‐cause mortality was reduced individuals admitted direct to the CCU compared with those admitted via the ER (11.5% 15.6%; p?