title: The impact of recommended percutaneous coronary intervention care on hospital outcomes for interhospital-transferred STEMI patients.
abstract: BACKGROUND
  Timely transfer and percutaneous coronary intervention (PCI) with or without thrombolysis are recommended by the American Heart Association (AHA) to care for ST-segment elevation myocardial infarction (STEMI) patients who present first to a non-PCI-capable hospital. This study was to evaluate the impact on in-hospital mortality of the compliance with guidelines regarding to the time of PCI for patients with STEMI who were transferred to a capable PCI hospital.
  
  
  METHODS
  We used the CArdioVAscular disease Surveillance data from November 2007 to December 2012 for this study. Adult patients who were diagnosed with STEMI and transferred from a primary hospital for PCI were included. Patients who underwent PCI or coronary artery bypass graft surgery in the primary hospital and patients with an unknown emergency department disposition were excluded. The main exposure was the AHA recommendation for reperfusion therapy. We tested the association between compliance with AHA and hospital mortality.
  
  
  RESULTS
  A total of 2078 patients were analyzed, 30.0% of whom were treated in compliance with the guidelines, whereas the remaining 70.0% were not. Thrombolysis was performed in 7.9% and 0.8% (P value < .01) and hospital mortality was 5.0% and 6.8% (P value = .11) in the compliant and violence groups, respectively. The adjusted odds ratios (95% confidence intervals) of the compliant group for hospital mortality were 0.75 (0.46-1.21), respectively. A sensitivity analysis of symptom onset to arrival time was a trend for a beneficial effect in the compliant group.
  
  
  CONCLUSIONS
  Among the patients who were transferred for STEMI care, undergoing PCI as recommended by the AHA was not associated with a mortality benefit, but the patients whose symptom onset to hospital arrival time was within 30 minutes showed an association between compliance and lower mortality.
authors: Department of Emergency Medicine, Seoul National University College of Medicine. Electronic address: d2uk87@gmail.com.
authors: YeongHo
authors: Y
authors: Choi
authors: Department of Emergency Medicine, National Medical Center. Electronic address: eyeblack99@gmail.com.
authors: Yu Jin
authors: YJ
authors: Lee
authors: Department of Emergency Medicine, Seoul National University College of Medicine. Electronic address: shinsangdo@medimail.co.kr.
authors: Sang Do
authors: SD
authors: Shin
authors: Department of Emergency Medicine, Seoul National University College of Medicine. Electronic address: skciva@gmail.com.
authors: Kyoung Jun
authors: KJ
authors: Song
authors: Department of Emergency Medicine, Seoul National University College of Medicine. Electronic address: cssurgeon@hanmail.net.
authors: KyungWon
authors: K
authors: Lee
authors: Department of Emergency Medicine, Seoul National University College of Medicine. Electronic address: ironlyj@gmail.com.
authors: Eui Jung
authors: EJ
authors: Lee
authors: Department of Emergency Medicine, Seoul National University Bundang Hospital, Republic of Korea. Electronic address: myda02@gmail.com.
authors: Yu Jin
authors: YJ
authors: Kim
authors: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute. Electronic address: arendt75@gmail.com.
authors: Ki Ok
authors: KO
authors: Ahn
authors: Department of Emergency Medicine, Seoul National University College of Medicine; Seoul Metropolitan Government Seoul National University Boramae Medical Center. Electronic address: emkjhong@gmail.com.
authors: Ki Jeong
authors: KJ
authors: Hong
authors: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute. Electronic address: Ro.youngsun@gmail.com.
authors: Young Sun
authors: YS
authors: Ro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000592:standards*; D062645:Percutaneous Coronary Intervention / Q000592:standards*; D017410:Practice Guidelines as Topic; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy; D061665:Time-to-Treatment / Q000592:standards*; D014481:United States; D055815:Young Adult