title: 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.
abstract: 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.
authors.affiliation: Cardiology Department, Complejo Hospitalario, Universitario A Coruña, La Coruña, Spain. Rodrigo.Estevez.Loureiro@sergars.es
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Estévez-Loureiro
authors.forename: Ramon
authors.initials: R
authors.lastname: Calviño-Santos
authors.forename: Jose-Manuel
authors.initials: JM
authors.lastname: Vázquez-Rodríguez
authors.forename: Raquel
authors.initials: R
authors.lastname: Marzoa-Rivas
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barge-Caballero
authors.forename: Jorge
authors.initials: J
authors.lastname: Salgado-Fernández
authors.forename: Guillermo
authors.initials: G
authors.lastname: Aldama-López
authors.forename: Maria
authors.initials: M
authors.lastname: Barreiro-Díaz
authors.forename: Jacobo
authors.initials: J
authors.lastname: Varela-Portas
authors.forename: Miguel
authors.initials: M
authors.lastname: Freire-Tellado
authors.forename: Nicolas
authors.initials: N
authors.lastname: Vázquez-González
authors.forename: Alfonso
authors.initials: A
authors.lastname: Castro-Beiras
mesh_terms: 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