title: Transfer times and outcomes in patients with ST-segment-elevation myocardial infarction undergoing interhospital transfer for primary percutaneous coronary intervention: APEX-AMI insights.
abstract: BACKGROUND
  Transfer delays for primary percutaneous coronary intervention may increase mortality in patients with ST-segment-elevation myocardial infarction. We examined the association between door 1-to-door 2 (D1D2) time, a measure capturing the entire transfer process, and outcomes in patients undergoing interhospital transfer for primary percutaneous coronary intervention.
  
  
  RESULTS
  We evaluated the relationship between D1D2 time and the 90-day incidence of death, shock, and heart failure in the subset of 2075 (36.1%) of 5745 patients who underwent interhospital transfer for primary percutaneous coronary intervention in the Assessment of Pexelizumab in Acute Myocardial Infarction trial. There was no significant difference in the 90-day incidence of death, shock, and heart failure between the transferred and the nontransferred groups (10.3% versus 10.2%; P = 0.89). The median difference in symptom-to-balloon time between the 2 groups was 45 minutes (229 versus 184; P<0.001). The primary outcome per 30-minute delay was higher for patients with a D1D2 time ≤150 minutes (hazard ratio, 1.19: 95% confidence interval, 1.06 to 1.33; P = 0.004) but not for D1D2 times >150 minutes (hazard ratio, 0.99: 95% confidence interval, 0.96 to 1.02; P = 0.496). The association between longer D1D2 time and worsening outcome was no longer statistically significant after multivariable adjustment.
  
  
  CONCLUSIONS
  Longer transfer times were associated with higher rate of death, shock, and heart failure among patients undergoing interhospital transfer from primary percutaneous coronary intervention, although this difference did not persist after adjusting for baseline characteristics.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. sv9@ualberta.ca
authors.forename: Sean
authors.initials: S
authors.lastname: van Diepen
authors.forename: Petr
authors.initials: P
authors.lastname: Widimsky
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
authors.forename: Kyle R
authors.initials: KR
authors.lastname: White
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Weaver
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: Diego
authors.initials: D
authors.lastname: Ardissino
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: van't Hof
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D016009:Chi-Square Distribution; D019033:Delivery of Health Care, Integrated; D004311:Double-Blind Method; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012769:Shock / Q000209:etiology / Q000401:mortality; D057127:Single-Chain Antibodies / Q000627:therapeutic use; D016019:Survival Analysis; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D057127:Single-Chain Antibodies; C402724:pexelizumab