Interhospital transfer of patients with ST-segment elevation myocardial infarction for percutaneous coronary intervention.
We investigated in 277 consecutive patients, mean age 63 years, with ST-segment elevation acute myocardial infarction transferred from 25 community hospitals to a tertiary percutaneous coronary intervention (PCI) center from a median distance of 21 miles the incidences of in-hospital mortality, stroke, and recurrent myocardial infarction associated with transfer times. Of the 277 patients, 158 (57%) had thrombolytic therapy at the referring hospital. Of the 277 patients, 63 (23%) had adjunctive PCI, 119 (43%) had primary PCI, and 95 (34%) had rescue PCI. Of the 277 patients, 42 (15%) were hemodynamically unstable. Median transfer times were 102 minutes with primary PCI, 119 minutes with rescue PCI, and 144 minutes for adjunctive PCI (P < 0.0001 for adjunctive PCI versus primary PCI; P = 0.011 for adjunctive PCI versus rescue PCI). Median transfer time was 98 minutes for hemodynamically unstable patients and 121 minutes for hemodynamically stable patients (P = 0.005). In-hospital death occurred in eight of 277 patients (3%). In-hospital stroke occurred in three of 277 patients (1%). In-hospital recurrent myocardial infarction occurred in none of 277 patients (0%). There was no association of transfer times with in-hospital mortality or stroke. In-hospital mortality occurred in three of 112 patients (3%) who had bare metal stents and in five of 165 patients (3%) who had drug-eluting stents.
Tsai
Fausan S
FS
Department of Medicine, Cardiology Division, New York Medical College, Valhalla, NY 10595, USA.
Mellana
William M
WM
Aronow
Wilbert S
WS
Ahn
Chul
C
Ferraris
Ambra
A
Dudha
Majid
M
Kalapatapu
Kumar
K
Pucillo
Anthony L
AL
Monsen
Craig E
CE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D017052:Hospital Mortality; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D010360:Patient Transfer; D012008:Recurrence; D020521:Stroke / Q000453:epidemiology; D015912:Thrombolytic Therapy