title: Long-term prognostic benefit of field triage and direct transfer of patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention.
abstract: Direct transfer (DT) to the catheterization laboratory has been demonstrated to reduce delays in primary percutaneous coronary intervention (PPCI). However, data with regard to its effect on long-term mortality are sparse. The aim of this study was to investigate the effect of DT on long-term mortality in patients with ST-segment elevation myocardial infarctions treated with PPCI. A cohort study was conducted of 1,859 patients (mean age 63.1 ± 13 years, 80.2% men) who underwent PPCI from May 2005 to December 2010. From the whole series, 425 patients (23%) were admitted by DT and 1,434 (77%) by emergency departments. DT patients were younger (mean age 61 ± 12 vs 64 ± 12 years, p = 0.017), were more frequently men (86% vs 76%, p = 0.001), and had a higher proportion of abciximab use (77% vs 64%, p <0.0001). The DT group had a shorter median contact-to-balloon time (105 vs 122 minutes, p <0.0001) and a shorter time to treatment (185 vs 255 minutes, p <0.0001) compared with the emergency department group. Thirty-day and long-term mortality (median follow-up 2.4 years, interquartile range 1.6 to 3.2) were lower in the DT group (3% vs 6%, p = 0.049, and 9.4% vs 14.4%, p = 0.008, respectively). An adjusted Cox regression analysis proved that the DT group had an improved prognosis during follow-up (hazard ratio 0.71, 95% confidence interval 0.50 to 0.99). In conclusion, DT of patients with ST-segment elevation myocardial infarctions for PPCI was associated with fewer delays and improved survival. This benefit was maintained after long follow-up. This strategy should be emphasized in all networks of ST-segment elevation myocardial infarction care.
authors.affiliation: Interventional Cardiology Unit, Cardiology Department, Complejo Hospitalario, Universitario A Coruña, La Coruña, Spain. rodrigo.estevez.loureiro@sergas.es
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Estévez-Loureiro
authors.forename: Ramón
authors.initials: R
authors.lastname: Calviño-Santos
authors.forename: Angela
authors.initials: A
authors.lastname: López-Sainz
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Vázquez-Rodríguez
authors.forename: María Rita
authors.initials: MR
authors.lastname: Soler-Martín
authors.forename: Oscar
authors.initials: O
authors.lastname: Prada-Delgado
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: Pablo
authors.initials: P
authors.lastname: Piñón-Esteban
authors.forename: Xacobe
authors.initials: X
authors.lastname: Flores-Ríos
authors.forename: María
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: Marcos
authors.initials: M
authors.lastname: García-Guimaraes
authors.forename: Nicolás
authors.initials: N
authors.lastname: Vázquez-González
authors.forename: Alfonso
authors.initials: A
authors.lastname: Castro-Beiras
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010360:Patient Transfer / Q000706:statistics & numerical data; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage / Q000706:statistics & numerical data