title: Hospital transfer for primary coronary angioplasty in high risk patients with acute myocardial infarction.
abstract: OBJECTIVE
  To investigate the feasibility, safety, and associated time delays of interhospital transfer in patients with acute myocardial infarction for primary percutaneous transluminal coronary angioplasty (PTCA).
  
  
  METHODS
  Prospective observational study with group comparison in a single centre. 68 consecutive patients with acute myocardial infarction transferred for primary PTCA from other hospitals (group A) were compared with 78 patients admitted directly to the referral centre (group B).
  
  
  METHODS
  Patient groups were analysed with regard to baseline characteristics, time intervals from onset of chest pain to balloon angioplasty, hospital stay, and follow up outcome.
  
  
  RESULTS
  Patients in group A presented with a higher rate of cardiogenic shock initially than patients in group B (25% v 6%, p = 0.01) and had been resuscitated more frequently before PTCA (22% v 5%, p = 0.01). No deaths or other serious complications occurred during interhospital transfer. Median transfer time was 63 (range 40-115) minutes for helicopter transport (median 42 (28-122) km, n = 14), and 50 (18-110) minutes by ground ambulance (median 8 (5-68) km, n = 54). The median time interval from the decision to perform coronary arteriography to balloon inflation was 96 (45-243) minutes in group A and 52 (17-214) minutes in group B (p = 0.0001). In transferred patients (group A) the transportation associated delay and the longer in-hospital median decision time (50 (10-1120) minutes in group A v 15 (0-210) minutes in group B, p = 0.002) concurred with a longer total period of ischaemia (239 (114-1307) minutes in group A v 182 (75-1025) minutes in group B, p = 0.02) since the beginning of chest pain. Success of PTCA (TIMI 3 flow in 95% of all patients), in-hospital mortality (7% v 9%, mortality for patients not in cardiogenic shock 0% v 4%), and follow up after median 235 days was similarly favourable in groups A and B, respectively. Only one hospital survivor (group A) died during follow up.
  
  
  CONCLUSIONS
  Interhospital transport for primary PTCA in high risk patients with acute myocardial infarction is safe and feasible within a reasonable period of time. Short and medium term outcome is favourable. Optimising the decision process and transport logistics may further improve outcome by reducing the total time of ischaemia.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Triemli Hospital, Birmensdorferstrasse 497, CH 8063 Zurich, Switzerland. estraumann@access.ch
authors.forename: E
authors.initials: E
authors.lastname: Straumann
authors.forename: S
authors.initials: S
authors.lastname: Yoon
authors.forename: B
authors.initials: B
authors.lastname: Naegeli
authors.forename: J
authors.initials: J
authors.lastname: Frielingsdorf
authors.forename: A
authors.initials: A
authors.lastname: Gerber
authors.forename: E
authors.initials: E
authors.lastname: Schuiki
authors.forename: O
authors.initials: O
authors.lastname: Bertel
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010360:Patient Transfer; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome