Direct transfer of ST-elevation myocardial infarction patients for primary percutaneous coronary intervention from short and long transfer distances decreases temporal delays and improves short-term prognosis: the PROGALIAM Registry.
OBJECTIVE
This study sought to evaluate the impact of a direct transfer strategy on treatment times and prognosis of patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous intervention (PPCI).


RESULTS
We conducted a cohort study of 1,194 patients who underwent PPCI in our centre between May 2005 and December 2008. We studied the role of direct transfer on time to treatment and door-to-balloon delays and its effect on 30-day mortality adjusted by risk profile on admission. During this period, 255 patients (21%) experienced direct transfer (DT) from the field to the catheterisation laboratory. Patients referred directly for PPCI experienced lower median door-to-balloon delay (102 minutes vs. 125 minutes, p<0.0001) and lower time to treatment (median 189 minutes vs. 259 minutes, p<0.0001) when compared with those referred from emergency departments (ED). These differences were consistent, with respect to door-to-balloon delay and time to treatment interval, in patients from our catchment area: median 88 vs. 98 minutes, (p=0.003) and 174 vs. 219 minutes (p<0.0001) respectively, and from long-distance transfer: 110 vs. 169 minutes (p<0.0001) and 197 minutes vs. 342 minutes (p<0.0001) respectively. Patients in the DT group experienced lower 30-day mortality than patients transferred from the ED (2.7% vs. 6.8%, p=0.017). In a multivariable analysis, DT strategy was independently associated with better short-term prognosis (OR 0.33, CI95% 0.12 - 0.92).


CONCLUSIONS
Direct transfer reduces time delays and improves prognosis of patients with STEMI undergoing PPCI.
Estévez-Loureiro
Rodrigo
R
Cardiology Department, Complejo Hospitalario, Universitario A Coruña, La Coruña, Spain. Rodrigo.Estevez.Loureiro@sergars.es
Calviño-Santos
Ramon
R
Vázquez-Rodríguez
Jose-Manuel
JM
Marzoa-Rivas
Raquel
R
Barge-Caballero
Eduardo
E
Salgado-Fernández
Jorge
J
Aldama-López
Guillermo
G
Barreiro-Díaz
Maria
M
Varela-Portas
Jacobo
J
Freire-Tellado
Miguel
M
Vázquez-González
Nicolas
N
Castro-Beiras
Alfonso
A
D015906:Angioplasty, Balloon, Coronary; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome