title: Direct Admission Versus Interhospital Transfer for Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction.
abstract: This study sought to assess the influence of direct admission versus transfer via regional hospital to a percutaneous coronary intervention (PCI) center on time delays and 12-month mortality in ST-segment elevation myocardial infarction (STEMI) patients from a real-life perspective.
  
  
  
  Reduction of delays to reperfusion is crucial in a STEMI system of care. However, it is still debated whether direct admission to a PCI center is superior to interhospital transfer in terms of long-term prognosis. The authors hypothesized that compared with interhospital transfer, direct admission shortens the total ischemic time, limits the loss of left ventricular systolic function, and finally, reduces 12-month mortality.
  
  
  
  Prospective nationwide registry data of STEMI patients admitted to PCI centers within 12 h of symptom onset and treated with PCI between 2006 and 2013 were analyzed. Patients admitted directly were compared with patients transferred to a PCI center via a regional non-PCI-capable facility in terms of time delays, left ventricular ejection fraction (LVEF), and 12-month mortality. Data were adjusted using propensity-matched and multivariate Cox analyses.
  
  
  
  Of the 70,093 patients eligible for analysis, 39,144 (56%) were admitted directly to a PCI center. Direct admission was associated with a shorter median symptoms-to-admission time (by 44 min; p < 0.001) and total ischemic time (228 vs. 270 min; p < 0.001), higher LVEF (47.5% vs. 46.3%; p < 0.001), and lower propensity-matched 12-month mortality (9.6% vs. 10.4%; p < 0.001). In propensity-matched multivariate Cox analysis, direct admission (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01 to 1.11) and shorter symptoms-to-admission time (HR: 1.03; 95% CI: 1.01 to 1.06) were significant predictors of lower 12-month mortality.
  
  
  
  In a large, community-based cohort of patients with STEMI treated by PCI, direct admission to a primary PCI center was associated with lower 12-month mortality and should be preferred to transfer via a regional non-PCI-capable facility.
authors.affiliation: 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland. Electronic address: d.kawecki@interia.pl.
authors.forename: Damian
authors.initials: D
authors.lastname: Kawecki
authors.affiliation: 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland; Department of Science, Training and New Medical Technologies, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Gierlotka
authors.affiliation: 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Morawiec
authors.affiliation: 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland; Department of Science, Training and New Medical Technologies, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Hawranek
authors.affiliation: 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland; Department of Science, Training and New Medical Technologies, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Tajstra
authors.affiliation: Department of Science, Training and New Medical Technologies, Silesian Center for Heart Diseases, Zabrze, Poland; Department of Biostatistics, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Skrzypek
authors.affiliation: 3rd Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Wojakowski
authors.affiliation: 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland; Department of Science, Training and New Medical Technologies, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
authors.affiliation: 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Nowalany-Kozielska
authors.affiliation: 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland; Department of Science, Training and New Medical Technologies, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Gąsior
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011044:Poland; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: 12-month mortality; STEMI networks; acute myocardial infarction; interhospital transfer; primary PCI; time delays