title: One-year clinical outcome of interventionalist- versus patient-transfer strategies for primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: results from the REVERSE-STEMI study.
abstract: BACKGROUND
  Traditional reperfusion options for patients with acute ST-segment elevation myocardial infarction (STEMI) presenting to non-primary percutaneous coronary intervention (PPCI)-capable hospitals generally include onsite fibrinolytics or emergency transfer for PPCI. A third option, involving interventionalist transfer, was examined in the REVERSE-STEMI study.
  
  
  RESULTS
  A total of 334 patients with acute STEMI who presented to 5 referral hospitals with angiographic facilities but without interventionalists qualified for PPCI were randomized to receive PPCI with either an interventionalist- (n=165) or a patient-transfer (n=169) strategy. The primary end point of door-to-balloon (D2B) time and secondary end points of left ventricular ejection fraction and major adverse cardiac events (MACE) at 1-year clinical follow-up were compared between the 2 groups. Compared with the patient-transfer strategy, the interventionalist-transfer strategy resulted in a significantly shortened D2B time (median, 92 minutes versus 141 minutes; P<0.0001), with more patients having first balloon angioplasty within 90 minutes (21.2% versus 7.7%, P<0.001). This treatment strategy also was associated with higher left ventricular ejection fraction (0.60±0.07 versus 0.57±0.09, P<0.001) and improved 1-year MACE-free survival (84.8% versus 74.6%, P=0.019). Multivariate Cox proportional hazards modeling revealed that the interventionalist-transfer strategy was an independent factor for reduced risk of composite MACE (hazard ratio, 0.63; 95% CI, 0.45 to 0.88; P=0.003).
  
  
  CONCLUSIONS
  The interventionalist-transfer strategy for PPCI may be effective in improving the care of patients with STEMI presenting to a non-PPCI-capable hospital, particularly in a congested cosmopolitan region where patient transfers could be prolonged.
authors.affiliation: Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui Jin Er Road, Shanghai, People’s Republic of China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.forename: Rui Yan
authors.initials: RY
authors.lastname: Zhang
authors.forename: Jian Ping
authors.initials: JP
authors.lastname: Qiu
authors.forename: Jun Feng
authors.initials: JF
authors.lastname: Zhang
authors.forename: Xiao Long
authors.initials: XL
authors.lastname: Wang
authors.forename: Li
authors.initials: L
authors.lastname: Jiang
authors.forename: Min Lei
authors.initials: ML
authors.lastname: Liao
authors.forename: Jian Sheng
authors.initials: JS
authors.lastname: Zhang
authors.forename: Jian
authors.initials: J
authors.lastname: Hu
authors.forename: Zheng Kun
authors.initials: ZK
authors.lastname: Yang
authors.forename: Wei Feng
authors.initials: WF
authors.lastname: Shen
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002681:China; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D018578:Hospital-Physician Relations; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D011364:Professional Practice; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D018581:Technology Transfer; D013997:Time Factors; D016896:Treatment Outcome