title: Prehospital Transfer Pathway and Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention.
abstract: BACKGROUND
  It is recommended that not only door-to-balloon time but also prehospital delay for primary percutaneous coronary intervention (PCI) should be improved. We investigated the effect of prehospital transfer pathway on onset-to-balloon time and prognosis in patients with ST-segment elevation myocardial infarction (STEMI) in Japan.
  
  
  RESULTS
  We analyzed data from 540 consecutive patients with primary PCI for STEMI. Patient clinical data and mortality were compared between patients who visited the family physician or non-PCI-capable hospitals and were then transferred to PCI-capable centers (indirect transfer patients), and those who directly visited PCI-capable centers (direct transfer patients). Onset-to-balloon time was longer in indirect transfer patients than in direct transfer patients (mean, 270 min; range, 180-480 min vs. 180 min, 120-240 min; P<0.001). In addition, patient prognosis was evaluated on Cox proportional regression analysis. Cardiac death and all-cause death were significantly higher in indirect transfer patients (odds ratios [OR], 2.17; 95% confidence intervals [95% CI]: 1.17-4.01, P=0.01; OR, 1.71; 95% CI: 1.09-2.68, P=0.02). These results were confirmed using propensity score matching for adjusted analyses.
  
  
  CONCLUSIONS
  Patients with indirect transfer to regional emergency departments of PCI centers had longer onset-to-balloon time and worse prognosis than those with direct transfer.
authors.affiliation: Department of Cardiovascular Medicine, Shonan Kamakura General Hospital.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Imori
authors.forename: Takeshi
authors.initials: T
authors.lastname: Akasaka
authors.forename: Koki
authors.initials: K
authors.lastname: Shishido
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ochiai
authors.forename: Kazuki
authors.initials: K
authors.lastname: Tobita
authors.forename: Futoshi
authors.initials: F
authors.lastname: Yamanaka
authors.forename: Shingo
authors.initials: S
authors.lastname: Mizuno
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003643:Death; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery*; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention; D013997:Time Factors