[Treatment of acute myocardial infarction by primary angioplasty on-site compared with treatment following interhospital transfer: short- and long-time clinical outcomes].
OBJECTIVE
Primary angioplasty is the treatment of first choice for patients with ST-segment elevation acute myocardial infarction. However, its use is limited as the majority of patients present at hospitals without a catheterization laboratory. The objective of this study was to determine short- and long-term outcomes of systematically implementing a primary angioplasty program at two hospitals, one of which did not have a catheterization laboratory.


METHODS
This prospective observational study involved consecutive patients with acute myocardial infarction and an indication for reperfusion therapy who were admitted to the two participating hospitals (Hospital 1 had a catheterization laboratory, while Hospital 2 did not) between January 2000 and April 2001. Clinical follow-up was performed at 1, 6 and 12 months.


RESULTS
The study included 222 patients: 158 in Hospital 1 and 64 in Hospital 2. The median (interquartile range) delays from door to angiography at Hospital 1 and Hospital 2 were 49.5 min (30.0-88.0 min) and 62.5 min (53.5-93.7 min), respectively (P=.001), and from symptoms to angiography, 162.5 min (105.0-247.5 min) and 187.5 min (131.2-288.7 min), respectively (P=.04). In-hospital and 1-year mortality rates were 12.2% and 15.3%, respectively, with no difference between the hospitals. The hospital of origin was not a determinant of either in-hospital mortality (odds ratio [OR]=1.42, 95% confidence interval [CI], 0.3-7.8) or 1-year mortality (HR=2.04, 95% CI, 0.74-5.61).


CONCLUSIONS
Patients with ST-segment elevation acute myocardial infarction who require interhospital transfer for primary angioplasty have a similar clinical outcome to those who are admitted to a hospital at which the procedure is available, provided transfer is undertaken under optimal conditions (i.e., with a suitable means of transport and a short transfer time).
Carrillo
Pilar
P
Servicio de Cardiología, Hospital Universitario de San Juan, Alicante, Spain. pcarrillo@ya.com
López-Palop
Ramón
R
Pinar
Eduardo
E
Saura
Daniel
D
Párraga
Manuel
M
Picó
Francisco
F
Valdés
Mariano
M
Bertomeu
Vicente
V
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010360:Patient Transfer; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome