62 Direct admission to PPCI centres in out of hospital cardiac arrests and effect on survival

Introduction Out of hospital cardiac arrests (OOHCA) are a significant cause of mortality in the UK. The commonest cause for this is an acute myocardial infarction. Despite advances in resuscitation and intensive care management, survival-to-discharge rates remain poor. In select patients who regain spontaneous circulation with high-risk features of acute coronary occlusion, the European Society of Cardiology recommends prompt invasive coronary angiography (ICA) and primary percutaneous coronary intervention (PPCI). Timely intervention in this patient group has been shown to improve outcomes. However, the transfer of OOHCA patients directly to centres providing PPCI is not uniformly practiced across the UK and ambulance service protocols vary regionally. This retrospective cohort study compared outcomes of OOHCA patients with high-risk features of acute coronary occlusion who were directly brought to a PPCI centre, against those transferred from non-PPCI centres. Methods Using the Myocardial Ischaemia National Audit Project database, all OOHCA patients between 1/3/20 – 31/3/23 undergoing invasive coronary angiography at PPCI centres in the region (Manchester Royal Infirmary or Wythenshawe Hospital) were identified. Patients were grouped based on whether they were admitted directly to a PPCI centre, or indirectly transferred from a non-PPCI centre. Baseline demographics and clinical characteristics were recorded (table 1), as well as call-to-balloon (CTB) time, procedural details and outcomes. The primary outcome of the study was survival to discharge. Results A total of 258 patients (61±12 years, 80% male) were included in the analysis. 146 (57%) were admitted directly to a PPCI centre and 112 (43%) were indirectly transferred. Comorbidities included hypertension (51%), hypercholesterolaemia (29%) and ischaemic heart disease (5%). 221 (86%) patients underwent PPCI, with the most frequent diagnosis being ST-elevation myocardial infarction (88%). The most common cause of death in hospital was ischaemic heart disease (93%). When comparing direct and indirect admissions to PPCI centres, there were no significant differences in baseline characteristics. The CTB time was 138 minutes, compared to 242 minutes (p<0.01) respectively. At discharge, survival rates were 117/146 (80%) for direct admissions, compared to indirect 73/112 (65%) (Hazard Ratio 0.54; 95% CI, 0.34 to 0.88; p=0.01) (figure 1). Conclusion Indirect transfers to PPCI centres for OOHCA were common. CTB times were significantly longer in this patient group and had a worse survival-to-discharge rate. In this select group of OOHCA patients with high-risk features of coronary artery occlusion, there appears to be benefit in direct transfer of care to a PPCI centre. Further research into organisational, logistic and financial feasibility of consolidating OOHCA care in regional PPCI centres will help to inform onward service improvement and management of these patients. Conflict of Interest None