title: Transfer distance effect on reperfusion: timeline of ST-elevation patients transferred for primary percutaneous coronary intervention.
abstract: OBJECTIVE
  This study aims to establish if transfer distance impacts the outcome of ST-elevation myocardial infarction (STEMI) patients transferred to a percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Regional emergency care systems were designed to decrease delays in reperfusion of patients but the effect of transfer distance on outcome is less established.
  
  
  METHODS
  We compare the characteristics and outcomes of STEMI patients transferred from a distance >25 miles (GT25) to those transferred from distances ≤25 miles (LT25) by utilizing data from a regional STEMI care network in the greater Washington DC area.
  
  
  RESULTS
  Within the transferred patients (n=1065), 609 patients (57%) were transferred from GT25 (median distance 36 miles), while 456 (43%) were transferred from LT25 (median distance 13 miles). Most of the baseline characteristics between the groups were similar. Door-to-balloon (DTB) was defined as the time elapsed from the presentation to the center without PCI capability to flow restoration in the culprit artery. No differences were noted in the median DTB (GT25: 158min [122-213] vs. 149 [118-219]; p=0.5) or in in-hospital mortality (8% vs. 7.2%; p=0.617). By implementing the regional STEMI care network, a constant decrease in DTB was noted throughout its years of operation.
  
  
  CONCLUSIONS
  For STEMI patients presenting to a non-PCI capable center, a network care system for PCI mitigates the distance factor on DTB time. This is turn translates into comparable outcomes.
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Sa'ar
authors.initials: S
authors.lastname: Minha
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Loh
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Lakshmana K
authors.initials: LK
authors.lastname: Pendyala
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Israel M
authors.initials: IM
authors.lastname: Barbash
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhaes
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D004219:District of Columbia; D004638:Emergency Treatment / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000097:blood; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Door-to-balloon time; Reperfusion; ST-elevation myocardial infarction