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June 1, 2020Open Access

Inter-hospital transfers and door-to-balloon times for STEMI: a single centre cohort study.

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Why the study?

When patients do not present to a 24/7 PCI-capable facility, delays can exceed the recommended 90 minutes; this study evaluated the impact of inter-hospital transfers on performance indices in STEMI.

Does inter-hospital transfer increase time to treatment in STEMI patients compared to direct presentation?

Population

Patients presenting with symptoms suggestive of ACS and admitted for PCI

Comparison

Transfers from a secondary non-PCI capable hospital vs direct presentations

Design

Single centre cohort study

Authors

RFRene K. ForsythZSZhong Hua SunCRChristopher M. Reid

Discussion

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Member takes

Overview

May increase ischemic burden in transferred STEMI patients; leaves open the need for outcome-focused trials on triage optimization.

Structured PICO

Does inter-hospital transfer increase time to treatment in STEMI patients compared to direct presentation?

P
Population
Patients presenting with symptoms suggestive of acute coronary syndromes (ACS) and admitted for percutaneous coronary intervention (PCI), diagnosed with ST-segment elevation myocardial infarction (STEMI).
I
Intervention
Transfer from a secondary non-PCI capable hospital.
C
Comparator
Direct presentation to a PCI-capable hospital.
O
Outcome
Time of treatment, including symptom-onset to PCI-capable hospital arrival, symptom-onset to balloon inflation, and PCI-capable hospital door-to-balloon times.

Inter-hospital transfer for STEMI significantly increases total ischemic time compared to direct presentation, despite similar door-to-balloon times at the receiving PCI-capable hospital.

Cite This Study

Forsyth et al. (2020) studied this question.

synapsesocial.com/papers/6a87db7df762332bf8fe86a7https://doi.org/10.11909/j.issn.1671-5411.2020.06.001
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Clinical impact of an inter-hospital transfer strategy in patients with ST-elevation myocardial infarction undergoing primary angioplasty: the Emilia-Romagna ST-segment elevation acute myocardial infarction network2008 · 62 citations
  2. 2Door‐to‐balloon times are reduced in ST‐elevation myocardial infarction by emergency physician activation of the cardiac catheterisation laboratory and immediate patient transfer2010 · 20 citations
  3. 3Time Delay to Treatment and Mortality in Primary Angioplasty for Acute Myocardial Infarction2004 · 1,557 citations
  4. 4Referral patterns of patients presenting with chest pain at two rural emergency departments in Western Australia2010 · 4 citations
  5. 5National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 20162016 · 317 citations