Direct Admission Versus Interhospital Transfer for Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction

Abstract Objectives This study sought to assess the influence of direct admission versus transfer via regional hospital to a percutaneous coronary intervention (PCI) center on time delays and 12-month mortality in ST-segment elevation myocardial infarction (STEMI) patients from a real-life perspecti...

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Veröffentlicht in:JACC. Cardiovascular interventions 2017-03, Vol.10 (5), p.438-447
Hauptverfasser: Kawecki, Damian, MD, PhD, Gierlotka, Marek, MD, PhD, Morawiec, Beata, MD, PhD, Hawranek, Michał, MD, PhD, Tajstra, Mateusz, MD, PhD, Skrzypek, Michał, PhD, Wojakowski, Wojciech, Poloński, Lech, Nowalany-Kozielska, Ewa, Gąsior, Mariusz
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Sprache:eng
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Zusammenfassung:Abstract Objectives This study sought to assess the influence of direct admission versus transfer via regional hospital to a percutaneous coronary intervention (PCI) center on time delays and 12-month mortality in ST-segment elevation myocardial infarction (STEMI) patients from a real-life perspective. Background Reduction of delays to reperfusion is crucial in a STEMI system of care. However, it is still debated whether direct admission to a PCI center is superior to interhospital transfer in terms of long-term prognosis. The authors hypothesized that compared with interhospital transfer, direct admission shortens the total ischemic time, limits the loss of left ventricular systolic function, and finally, reduces 12-month mortality. Methods Prospective nationwide registry data of STEMI patients admitted to PCI centers within 12 h of symptom onset and treated with PCI between 2006 and 2013 were analyzed. Patients admitted directly were compared with patients transferred to a PCI center via a regional non–PCI-capable facility in terms of time delays, left ventricular ejection fraction (LVEF), and 12-month mortality. Data were adjusted using propensity-matched and multivariate Cox analyses. Results Of the 70,093 patients eligible for analysis, 39,144 (56%) were admitted directly to a PCI center. Direct admission was associated with a shorter median symptoms-to-admission time (by 44 min; p < 0.001) and total ischemic time (228 vs. 270 min; p < 0.001), higher LVEF (47.5% vs. 46.3%; p < 0.001), and lower propensity-matched 12-month mortality (9.6% vs. 10.4%; p < 0.001). In propensity-matched multivariate Cox analysis, direct admission (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01 to 1.11) and shorter symptoms-to-admission time (HR: 1.03; 95% CI: 1.01 to 1.06) were significant predictors of lower 12-month mortality. Conclusions In a large, community-based cohort of patients with STEMI treated by PCI, direct admission to a primary PCI center was associated with lower 12-month mortality and should be preferred to transfer via a regional non–PCI-capable facility.
ISSN:1936-8798
1876-7605
DOI:10.1016/j.jcin.2016.11.028