title: Improved Survival of Patients with ST-Segment Elevation Myocardial Infarction 3-6 Hours After Symptom Onset Is Associated with Inter-Hospital Transfer for Primary Percutaneous Coronary Intervention (PCI) at a Large Regional ST-Segment Elevation Myocardial Infarction (STEMI) Program vs. In-Hospital Thrombolysis in a Community Hospital.
abstract: BACKGROUND This study sought to compare the 30-day and 1-year survival of patients diagnosed with ST-segment elevation myocardial infarction (STEMI), whose symptom onset to in-hospital first medical contact (IHFMC) was 3-6 h, who received either in-hospital thrombolysis (IHT) in the nearest county hospital or direct transfer to a larger hospital in Henan province, China for primary percutaneous coronary intervention (PPCI). MATERIAL AND METHODS Patients were allocated into 2 groups: one group received IHT in the local county hospital, whereas the other group were transferred to the PCI centers to receive PPCI. Patient demographic data, baseline characteristics, and time between different stages of patient contact to the initiation of treatment for IHT or PPCI were recorded for analysis. RESULTS No significant difference was identified between the 2 groups with the baseline characteristics and demographic data. The all-cause mortality was not significantly different between the IHT and PPCI group at 30 days (13.0% vs. 9.9%, p=0.386). However, a significant difference in mortality between the IHT and PPCI group was observed at 1 year (23.4% vs. 14.1%, p=0.035). Inter-hospital transfer time for PPCI tended to be the independent predictor for survival (OR: 4.4 CI 95%: 1.9-14.5, p 0.001). Overall, the patients undergoing PPCI in inter-hospital transfer had a higher survival rates for 1 year compared with patients receiving IHT. CONCLUSIONS Despite the delay associated with inter-hospital transfer for PPCI, patients with STEMI 3-6 h after symptom onset have improved survival with PPCI over patients treated locally with IHT.
authors.affiliation: Deparment of Emergency, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland).
authors.forename: Xiangmei
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Deparment of Emergency, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland).
authors.forename: Xianzhi
authors.initials: X
authors.lastname: Yang
authors.affiliation: Deparment of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland).
authors.forename: Chuanyu
authors.initials: C
authors.lastname: Gao
authors.affiliation: Deparment of Emergency, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland).
authors.forename: Yingjie
authors.initials: Y
authors.lastname: Chu
authors.affiliation: Deparment of Emergency, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland).
authors.forename: Lei
authors.initials: L
authors.lastname: Yang
authors.affiliation: Deparment of Emergency, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland).
authors.forename: Lixiao
authors.initials: L
authors.lastname: Tian
authors.affiliation: Deparment of Emergency, Zhengzhou University People's Hospital, Zhengzhou, Henan, China (mainland).
authors.forename: Lin
authors.initials: L
authors.lastname: Li
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D002681:China; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality*; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods / Q000401:mortality*; D061665:Time-to-Treatment