title: Infarct size in primary angioplasty without on-site cardiac surgical backup versus transferal to a tertiary center: a single photon emission computed tomography study.
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PCI) performed in large community hospitals without cardiac surgery back-up facilities (off-site) reduces door-to-balloon time compared with emergency transferal to tertiary interventional centers (on-site). The present study was performed to explore whether off-site PCI for acute myocardial infarction results in reduced infarct size.
  
  
  RESULTS
  One hundred twenty-eight patients with acute ST-segment elevation myocardial infarction were randomly assigned to undergo primary PCI at the off-site center (n = 68) or to transferal to an on-site center (n = 60). Three days after PCI, (99m)Tc-sestamibi SPECT was performed to estimate infarct size. Off-site PCI significantly reduced door-to-balloon time compared with on-site PCI (94 +/- 54 versus 125 +/- 59 min, respectively, p < 0.01), although symptoms-to-treatment time was only insignificantly reduced (257 +/- 211 versus 286 +/- 146 min, respectively, p = 0.39). Infarct size was comparable between treatment centers (16 +/- 15 versus 14 +/- 12%, respectively p = 0.35). Multivariate analysis revealed that TIMI 0/1 flow grade at initial coronary angiography (OR 3.125, 95% CI 1.17-8.33, p = 0.023), anterior wall localization of the myocardial infarction (OR 3.44, 95% CI 1.38-8.55, p < 0.01), and development of pathological Q-waves (OR 5.07, 95% CI 2.10-12.25, p < 0.01) were independent predictors of an infarct size > 12%.
  
  
  CONCLUSIONS
  Off-site PCI reduces door-to-balloon time compared with transferal to a remote on-site interventional center but does not reduce infarct size. Instead, pre-PCI TIMI 0/1 flow, anterior wall infarct localization, and development of Q-waves are more important predictors of infarct size.
authors: Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Paul
authors: P
authors: Knaapen
authors: Maarten
authors: M
authors: de Mulder
authors: Friso M
authors: FM
authors: van der Zant
authors: Hans O
authors: HO
authors: Peels
authors: Jos W R
authors: JW
authors: Twisk
authors: Albert C
authors: AC
authors: van Rossum
authors: Jan H
authors: JH
authors: Cornel
authors: Victor A W M
authors: VA
authors: Umans
mesh_terms: D000800:Angioplasty, Balloon; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000201:enzymology / Q000473:pathology* / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging; D010360:Patient Transfer; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D017256:Technetium Tc 99m Sestamibi