title: Impact of transfer time on mortality in acute coronary syndrome with ST-segment elevation treated by angioplasty.
abstract: BACKGROUND
  In primary percutaneous coronary intervention (pPCI), conflicting data exist on the relative importance of patient presentation time (time from symptom onset (SO) to first medical contact [FMC]) and transfer time (time from FMC to sheath insertion).
  
  
  OBJECTIVE
  To evaluate the impact of transfer time on mortality in an unselected ST-elevation myocardial infarction (STEMI) population treated with pPCI.
  
  
  METHODS
  In a well-organized urban network, using mobile intensive care units (MICU) whenever possible, the impact of transfer time on inhospital mortality was evaluated in 703 unselected consecutive STEMI patients transferred for pPCI.
  
  
  RESULTS
  Our STEMI population included patients with cardiogenic shock (5.3%) and out-of-hospital cardiac arrest (3.7%). Longer transfer times were found to be associated with a stepwise increase in mortality ranging from 2.99% in the first quartile (Q1) up to 8.65% in the fourth quartile (Q4) (P=0.005). This result was noted in patients presenting early (≤2h of SO, 0.96% for Q1 vs. 9.8% for Q4, P=0.006) but not in late presenters (>2h of SO, 7.00% for Q1 vs. 7.8% for Q4, P=0.85). After adjustment for confounding variables such as the severity of patients, the relationship between mortality and transfer time was no longer apparent.
  
  
  CONCLUSIONS
  In a well-organized urban network dedicated to pPCI, including unselected STEMI patients, transfer time does not appear to be a major contributor to mortality. The relationship of transfer time to mortality seems to be dependent on presentation time and patients' clinical severity.
authors.affiliation: Institut de Cardiologie, Inserm, Pitié-Salpêtrière Hospital (AP-HP), Université Paris, Paris, France.
authors.forename: Johanne
authors.initials: J
authors.lastname: Silvain
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Vignalou
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
authors.forename: Stephen A
authors.initials: SA
authors.lastname: O'Connor
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthélémy
authors.forename: Franck
authors.initials: F
authors.lastname: Boccara
authors.forename: Patrick
authors.initials: P
authors.lastname: Ecollan
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Patrick
authors.initials: P
authors.lastname: Assayag
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013997:Time Factors