Fibrinolysis versus primary percutaneous intervention in ST-elevation myocardial infarction with long interhospital transfer distances.
BACKGROUND
Current guidelines recommend rapid initiation of reperfusion therapy for ST-elevation myocardial infarction (STEMI), with short-distance transfer for primary percutaneous coronary intervention (pPCI) preferred over fibrinolysis in non-pPCI-capable hospitals. Comparative outcomes in patients with longer transfer times are unclear.


OBJECTIVE
We designed this study to assess whether administering fibrinolytics prior to initiating longer-distance interhospital transfer in patients with STEMI leads to a delay in transfer or worse outcomes compared with transfer for pPCI.


METHODS
We analyzed 259 STEMI patients transferred to a receiving pPCI-capable center in eastern North Carolina. The patients were divided into 2 groups, with 43 (16.6%) transferred for pPCI and the remaining 216 (83.4%) transferred following fibrinolysis. The primary endpoint was door-to-door time. We also compared stroke, death, significant bleeding, and combined outcomes between the 2 groups.


RESULTS
The median door-to-door time was similar for pPCI and fibrinolysis patients (135 vs 128 minutes; P = 0.71). Median door-to-balloon time among pPCI patients was 182 minutes from the point of arrival at the referral hospital and 49 minutes from arrival at the receiving pPCI center. Median door-to-needle time in the fibrinolysis patients was 30 minutes, with rescue PCI eventually performed in 81 (37.5%) patients. In-hospital mortality was higher in patients with pPCI (9.3%) compared with fibrinolysis patients (1.9%; P = 0.03). Combined incidence of stroke, significant bleeding, and death was 14% in pPCI patients compared with 7% in fibrinolysis patients (P = 0.13).


CONCLUSIONS
In settings with longer transfer distances, administering fibrinolytics prior to transfer to a pPCI-capable center did not cause any significant delay in transfer or worse outcomes.
East Carolina University/Pitt County Memorial Hospital, Greenville, North Carolina, USA. abhiberi@gmail.com
Abhimanyu
A
Beri
Mary
M
Printz
Ansar
A
Hassan
Joseph D
JD
Babb
D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D015425:Myocardial Reperfusion; D009657:North Carolina; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents