title: Primary angioplasty in acute myocardial infarction at hospitals with no surgery on-site (the PAMI-No SOS study) versus transfer to surgical centers for primary angioplasty.
abstract: OBJECTIVE
  To investigate primary angioplasty (PA) for high-risk acute myocardial infarction (AMI) at hospitals with no cardiac surgery on-site (No SOS), we hypothesized that a nonrandomized registry of such patients treated with PA would show clinical outcomes similar to those of a group randomized to transfer for PA, and that reperfusion would occur faster.
  
  
  BACKGROUND
  Primary angioplasty provides outcomes superior to fibrinolytic therapy in AMI, but its use in community hospitals with No SOS has been limited.
  
  
  METHODS
  Fibrinolytic-eligible patients with high-risk AMI prospectively consented if they had one or more high-risk characteristic. Nineteen hospitals with No SOS prospectively enrolled 500 patients for PA on-site. Seventy-one similar Air Primary Angioplasty in Myocardial Infarction trial patients were randomized to transfer for PA.
  
  
  RESULTS
  Primary angioplasty was performed in 88% of patients. Patients transferred for PA had a longer mean time to treatment (187 vs. 120 min; p < 0.0001). Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 was achieved in 96% for on-site PA, 86% in the transfer group (p = 0.004). The combined primary end point of 30-day mortality, re-infarction, and disabling stroke occurred in 27 (5%) on-site PA patients and 6 (8.5%) transfer patients (p = 0.27). Unadjusted one-year mortality was improved in on-site PA patients compared with those transferred (6% vs. 13%, p = 0.043), but after adjustment for differences in baseline variables, this difference was not significant.
  
  
  CONCLUSIONS
  On-site PA and transfer groups had similar 30-day outcomes and more rapid reperfusion for on-site PA. Primary angioplasty in high-risk AMI patients at hospitals with No SOS is safe, effective, and faster than PA after transfer to a surgical facility.
authors.affiliation: Division of Cardiology, Exeter Hospital, Exeter, New Hampshire, USA. tom.wharton@comcast.net
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Wharton
authors.forename: Lorelei L
authors.initials: LL
authors.lastname: Grines
authors.forename: Mark A
authors.initials: MA
authors.lastname: Turco
authors.forename: James D
authors.initials: JD
authors.lastname: Johnston
authors.forename: Jane
authors.initials: J
authors.lastname: Souther
authors.forename: David C
authors.initials: DC
authors.lastname: Lew
authors.forename: Ajazuddin Z
authors.initials: AZ
authors.lastname: Shaikh
authors.forename: William
authors.initials: W
authors.lastname: Bilnoski
authors.forename: Sushil K
authors.initials: SK
authors.lastname: Singhi
authors.forename: A Ersin
authors.initials: AE
authors.lastname: Atay
authors.forename: Nancy
authors.initials: N
authors.lastname: Sinclair
authors.forename: Dawn E
authors.initials: DE
authors.lastname: Shaddinger
authors.forename: Mark
authors.initials: M
authors.lastname: Barsamian
authors.forename: Mariann
authors.initials: M
authors.lastname: Graham
authors.forename: Judith
authors.initials: J
authors.lastname: Boura
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D009873:Operating Rooms; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D014481:United States; D014850:Waiting Lists