title: Inter-Facility Transfer vs. Direct Admission of Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.
abstract: BACKGROUND
  Inter-facility transfer for primary percutaneous coronary intervention (PCI) from referring facilities to PCI centers causes a significant delay in treatment of ST-segment elevation acute myocardial infarction (STEMI) patients undergoing primary PCI. However, little is known about the clinical outcomes of STEMI patients undergoing inter-facility transfer in Japan.
  
  
  RESULTS
  In the CREDO-Kyoto acute myocardial infarction (AMI) registry that enrolled 5,429 consecutive AMI patients in 26 centers in Japan, the current study population consisted of 3,820 STEMI patients who underwent primary PCI within 24 h of symptom onset. We compared long-term clinical outcomes between inter-facility transfer patients and those directly admitted to PCI centers. The primary outcome measure was a composite of all-cause death or heart failure (HF) hospitalization. There were 1,725 (45.2%) inter-facility transfer patients, and 2,095 patients (54.8%) with direct admission to PCI centers. The cumulative 5-year incidence of death/HF hospitalization was significantly higher in the inter-facility transfer patients than in those with direct admission (26.9% vs. 22.2%; log-rank P<0.001). After adjusting for potential confounders, the risk for death/HF hospitalization was significantly higher (adjusted hazard ratio: 1.22, 95% confidence interval: 1.07-1.40, P<0.001) in the inter-facility transfer patients than in those directly admitted.
  
  
  CONCLUSIONS
  Inter-facility transfer was associated with significantly worse long-term clinical outcomes for patients with STEMI undergoing primary PCI. (Circ J 2016; 80: 1764-1772).
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakatsuma
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Suwa
authors.forename: Minoru
authors.initials: M
authors.lastname: Horie
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention; D012042:Registries; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000601:surgery*