Key result
Direct PCI admission in AMI is linked to ~37% lower 2-year cardiac death versus inter-hospital transfer.
Why the study?
This study evaluated whether direct admission versus inter-hospital transfer to a PCI-capable hospital influences cardiac mortality in patients with acute myocardial infarction.
Does direct admission to a PCI-capable hospital reduce cardiac mortality in patients with acute myocardial infarction compared to inter-hospital transfer?
Observational (n=3,178)
No
Does direct admission to a PCI-capable hospital reduce cardiac mortality in patients with acute myocardial infarction compared to inter-hospital transfer?
Direct admission to a PCI-capable hospital is associated with significantly lower long-term cardiac mortality and shorter symptom onset-to-balloon times compared to inter-hospital transfer in patients with acute myocardial infarction.
Direct admission may lower cardiac mortality in AMI; observational data leave open need for randomized confirmation before practice change.
Appropriate risk stratification and timely revascularization of acute myocardial infarction (AMI) are available in percutaneous coronary intervention (PCI) - capable hospitals (PCHs). This study evaluated whether direct admission vs inter-hospital transfer influences cardiac mortality in patients with AMI. This study was conducted in the PCH where the patients were able to arrive within an hour. The inclusion criteria were AMI with a symptom onset time within 24 hours and having undergone PCI within 24 hours after admission. The cumulative incidence of cardiac death after percutaneous coronary intervention was evaluated in the direct admission versus inter-hospital transfer groups. Among the 3178 patients, 2165 (68.1%) were admitted via inter-hospital transfer. Patients with ST-segment elevation myocardial infarction (STEMI) in the direct admission group had a reduced symptom onset-to-balloon time (121 minutes, P < .001). With a median period of 28.4 (interquartile range, 12.0-45.6) months, the cumulative incidence of 2-year cardiac death was lower in the direct admission group (NSTEMI, 9.0% vs 11.0%, P = .136; STEMI, 9.7% vs 13.7%, P = .040; AMI, 9.3% vs 12.3%, P = .014, respectively). After the adjustment for clinical variables, inter-hospital transfer was the determinant of cardiac death (hazard ratio, 1.59; 95% confidence interval, 1.08-2.33; P = .016). Direct PCH admission should be recommended for patients with suspected AMI and could be a target for reducing cardiac mortality.
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Kang et al. (2021) conducted an observational in Acute myocardial infarction (AMI) (n=3,178). Direct admission to PCI-capable hospital vs. Inter-hospital transfer was evaluated on 2-year cardiac death (HR 1.59, 95% CI 1.08-2.33, p=0.016). Direct admission to a PCI-capable hospital significantly reduced the 2-year cumulative incidence of cardiac death compared to inter-hospital transfer in patients with acute myocardial infarction.
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