title: In-hospital outcomes of a regional ST-segment elevation myocardial infarction acute transfer and repatriation program.
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) presents challenges in a large geographic area for achieving treatment time targets and creates demands on the PCI centre resources.
  
  
  OBJECTIVE
  We compare the in-hospital mortality rate of patients presenting with STEMI and referred for PCI from 11 transfer hospitals with those presenting to the cardiac centre in a regional STEMI program with a selective repatriation strategy.
  
  
  METHODS
  Between June 1, 2003, and June 30, 2007, clinical and procedural data of all STEMI patients who were referred to the catheterization laboratory were prospectively collected. Patients who sustained prolonged cardiac arrest were excluded.
  
  
  RESULTS
  A total of 1154 patients from regional hospitals and 325 patients initially presenting to the PCI centre were referred for acute intervention. There was no significant in-hospital mortality difference between the 2 groups (3.7% vs 4.0%, respectively; P = 0.87). Multiple logistic regression analysis showed that advanced age, female gender, multivessel coronary disease, history of hypertension, low ejection fraction, increased left ventricular end-diastolic pressure, and thrombolytic pretreatment, but not transfer status, were independent predictors for mortality. Among the 1154 transfer patients, 937 patients (81.2%) returned immediately post procedure and had a lower mortality rate than the remaining 217 patients (18.2%) who required admission to the PCI centre following cardiac catheterization (1.9% vs 11.5%, P < 0.001).
  
  
  CONCLUSIONS
  A regional system of STEMI care based on rapid patient transfer to a PCI centre and repatriation was feasible and safe.
authors.affiliation: Department of Cardiac Services, Royal Columbian Hospital, New Westminster, British Columbia, Canada. albert.chan@fraserhealth.ca
authors.forename: Albert W
authors.initials: AW
authors.lastname: Chan
authors.forename: Shahrukh N
authors.initials: SN
authors.lastname: Bakar
authors.forename: Robert I
authors.initials: RI
authors.lastname: Brown
authors.forename: Robin
authors.initials: R
authors.lastname: Kuritzky
authors.forename: Akbar
authors.initials: A
authors.lastname: Lalani
authors.forename: Wendy
authors.initials: W
authors.lastname: Gordon
authors.forename: Carol G
authors.initials: CG
authors.lastname: Laberge
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Simkus
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D010360:Patient Transfer; D013997:Time Factors; D016896:Treatment Outcome