Efficacy and safety of an hub and spoke circuit for NSTEMI patients in italy

Background The "hub-and-spoke" (H&S) strategy refers to the transfer of a hospitalized patient from a peripheral (Spoke) hospital to a central (Hub) center for angiographic evaluation and potential percutaneous coronary intervention (PCI), followed by a timely return (within the same day) to the hospital of origin, avoiding the saturation of the coronary intensive care units of the Hub center. The objective of this study is to compare the hub-and-spoke strategy with the single-center approach. Methods Retrospective multicenter cohort study of NSTEMI in Italy. We compared the H&S compared to the single center in-hospital strategy. The primary endpoints were all-cause in-hospital mortality, the need for mechanical circulatory support (Impella or intra-aortic balloon pump [IABP]), acute definite stent thrombosis, major bleeding, acute kidney injury and major access site vascular complications during the hospitalization. Results A total of 1702 patients were included in our registry from 2020 to 2024, of which 820 (48.2%) were enrolled in the spoke and hub circuit and 882 (51.8%) in the single center approach. S&H patients were predominantly male, and older compared to the single center approach. There was one death in the S&H group (not related to the transport) and two deaths in the single hospital group. The incidence of mechanical circulatory support, acute definite stent thrombosis, major bleeding, acute kidney injury and major access site vascular complication incidence was low and similar in both groups (all p value > 0.05). Conclusions The hub-and-spoke circuit represents an efficient and safe method for revascularization in patients with NSTEMI, saving time and resources in order to provide a complete revascularization.