The safety and feasibility of immediately returning patients transferred for primary percutaneous coronary intervention with ST-elevation myocardial infarction.
OBJECTIVE
To describe the safety of immediate retransfer to community hospitals following primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).


RESULTS
In a cohort of 246 consecutive patients transferred to a tertiary institution who all underwent primary or rescue PCI, 166 (67%) were immediately retransferred back. The retransfer occurred only if they were haemodynamically stable and had undergone an uncomplicated procedure. In-hospital adverse events were assessed in each referral hospital. Patients had a mean age of 59 years, presented an anterior MI in 39%, and 91% were in Killip class 1. In this cohort, 75% of patients underwent primary PCI and 25% received rescue PCI. A transradial approach was used in 74% of patients. During ambulance transport back to the referral hospital, no adverse events occurred. In-hospital outcomes were favourable, with low death (2.4%), reinfarction (3.6%) and stroke (1.2%) rates. TIMI major bleeding occurred in 1.8% (catheter-related in 0.6%).


CONCLUSIONS
In this carefully selected population of STEMI patients, immediate retransfer to the referral hospital following primary or rescue PCI is feasible in more than 2/3 of patients and associated with a low risk of major clinical adverse events.
Division of Cardiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
Alexis
A
Matteau
Stéphane
S
Rinfret
Marc
M
Dorais
Jacques
J
Lelorier
François
F
Reeves
D000368:Aged; D000552:Ambulances; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology; D017052:Hospital Mortality; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010360:Patient Transfer; D011792:Quebec; D012008:Recurrence; D012017:Referral and Consultation; D012041:Regional Medical Programs; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome