title: The impact of transferring patients with ST-segment elevation myocardial infarction to percutaneous coronary intervention-capable hospitals on clinical outcomes.
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PCI) is recommended for ST-segment elevation myocardial infarction (STEMI) patients even when the patient must be transported to a PCI-capable hospital. This study aimed to evaluate the long-term clinical outcomes of STEMI patients who were transferred for primary PCI compared to patients who arrived directly to PCI-capable hospitals.
  
  
  METHODS
  A total of 3,576 STEMI patients with less than 12 h of symptom onset-to-door time from the Korea Acute Myocardial Infarction Registry were divided into transfer (n = 2,176) and direct-arrival (n = 1,400) groups according to their status. The primary outcome was the composite of major adverse cardiac event (MACE), defined as death, non-fatal myocardial infarction, and revascularization at 1 year.
  
  
  RESULTS
  In the transfer vs. the direct-arrival group, the median symptom onset-to-firstmedical contact time was significantly shorter (60 vs. 80 min, p < 0.001), but the median symptom onset-to-door time was significantly longer (194 vs. 90 min, p < 0.001). The median door-to-balloon time was significantly shorter in the transfer group vs. the direct-arrival group (75 vs. 91 min, p < 0.001). Total death and the composite of MACE were not significantly different during hospitalization (5.1 vs. 3.9%, p = 0.980; 5.4 vs. 4.8%, p = 0.435, respectively) and at 1-year (8.2 vs. 6.6%, p = 0.075; 13.7 vs. 13.9%, p = 0.922, respectively).
  
  
  CONCLUSIONS
  Transferring STEMI patients to PCI-capable hospitals with a time delay did not affect clinical outcomes after 1 year. This study suggests that inter-hospital transfer should be encouraged even with delay for STEMI patients who require primary PCI in areas with a similar geographic accessibility.
authors.forename: Bo Won
authors.initials: BW
authors.lastname: Kim
authors.affiliation: Pusan National University Hospital, Busan, South Korea. chakws1@hanmail.net.
authors.forename: Kwang Soo
authors.initials: KS
authors.lastname: Cha
authors.forename: Min Joung
authors.initials: MJ
authors.lastname: Park
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Yun
authors.forename: Jin Sup
authors.initials: JS
authors.lastname: Park
authors.forename: Hye Won
authors.initials: HW
authors.lastname: Lee
authors.forename: Jun-Hyok
authors.initials: JH
authors.lastname: Oh
authors.forename: Jeong Su
authors.initials: JS
authors.lastname: Kim
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Young Hyun
authors.initials: YH
authors.lastname: Park
authors.forename: Han Cheol
authors.initials: HC
authors.lastname: Lee
authors.forename: June Hong
authors.initials: JH
authors.lastname: Kim
authors.forename: Kook Jin
authors.initials: KJ
authors.lastname: Chun
authors.forename: Taek Jong
authors.initials: TJ
authors.lastname: Hong
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
mesh_terms: D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: comparative effectiveness research; myocardial infarction; percutaneous coronary intervention; transfer