title: Clinical impact of an inter-hospital transfer strategy in patients with ST-elevation myocardial infarction undergoing primary angioplasty: the Emilia-Romagna ST-segment elevation acute myocardial infarction network.
abstract: OBJECTIVE
  This study sought to evaluate the impact of an inter-hospital transfer strategy on treatment times and in-hospital and 1 year cardiac mortality of patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous intervention (p-PCI) in the Italian region of Emilia-Romagna, where an efficient region-wide system for reperfusion has been established.
  
  
  RESULTS
  3296 patients with STEMI, undergoing on-site p-PCI (2444 patients) (OS group) or p-PCI after inter-hospital transfer (852 patients) (T group) between 1 January 2004 and 30 June 2006 in the Italian region of Emilia-Romagna, were considered. During the study period, the number of patients undergoing p-PCI increased both for patients admitted to interventional centres and for those admitted to peripheral hospitals. At the same time, the proportion of patients with STEMI initially admitted to peripheral hospitals and not transferred and the door-to-balloon time delays of transfer patients decreased. In spite of longer door-to-balloon delay in the transfer group [112 min (86-147) vs. 71 min (46-104)], in-hospital cardiac mortality (OS 7.0 vs. T 5.4%, P = 0.10) did not significantly differ between the two groups. After multivariable adjustment, the transfer strategy was not associated with increased risk of in-hospital [odds ratio 0.956; 95% confidence interval (CI) 0.633-1.442] and 1 year (hazard ratio 0.817; 95% CI 0.617-1.085) cardiac mortality.
  
  
  CONCLUSIONS
  This study, concerning an established STEMI regional network, suggests that a strategy of inter-hospital transfer for p-PCI, when supported by an organized system of care, may be applied with rapid reperfusion times and favourable short- and long-term clinical outcomes.
authors.affiliation: Unità Operativa di Cardiologia Interventistica, Ospedale S Maria Nuova, Viale Risorgimento n 80, 42100 Reggio Emilia, Italy. manari.antonio@asmn.re.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Manari
authors.forename: Paolo
authors.initials: P
authors.lastname: Ortolani
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.forename: Gianni
authors.initials: G
authors.lastname: Casella
authors.forename: Luigi
authors.initials: L
authors.lastname: Vignali
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Varani
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Piovaccari
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Guiducci
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Percoco
authors.forename: Stefano
authors.initials: S
authors.lastname: Tondi
authors.forename: Francesco
authors.initials: F
authors.lastname: Passerini
authors.forename: Andrea
authors.initials: A
authors.lastname: Santarelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D015425:Myocardial Reperfusion / Q000379:methods; D010360:Patient Transfer / Q000458:organization & administration / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D015607:Stents; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents