Key result
Transfer for primary PCI was not associated with a significant difference in in-hospital major cardiovascular events compared to direct onsite presentation.
Why the study?
Does transfer from a non-PCI facility compared to direct presentation to a PCI facility affect in-hospital major cardiovascular events in patients with STEMI undergoing primary PCI?
Cohort (n=1,236)
Yes
Does transfer from a non-PCI facility compared to direct presentation to a PCI facility affect in-hospital major cardiovascular events in patients with STEMI undergoing primary PCI?
Transferring STEMI patients from non-PCI to PCI facilities within an integrated regional program results in equivalent in-hospital clinical outcomes compared to direct presentation, despite longer door-to-balloon times.
Answers are grounded in this paper and cite their sources.
Transfer not linked to higher events; leaves open transfer safety in STEMI, needing prospective confirmation.
BACKGROUND: It is currently unknown if the delay due to practical aspects associated with transfer of patients from a non-percutaneous coronary intervention (PCI) facility to a primary PCI facility is associated with adverse outcomes. METHODS: We conducted a retrospective cohort study of all patients who presented with ST-segment elevation myocardial infarction (STEMI) and underwent primary PCI in 2 large regional STEMI centers in Massachusetts between January 2005 and June 2009. The cohort was divided into onsite patients who presented directly to the primary PCI center and transferred patients referred from another facility. The primary outcome was a composite of in-hospital major cardiovascular events (death, myocardial infarction, and stroke). Secondary outcomes were the individual components of the composite endpoint and bleeding complications. RESULTS: The cohort included a total of 1236 patients. Among them, 426 (34%) patients were transferred patients and 810 (66%) were onsite patients. The median door to balloon time was significantly higher at for transferred patients (124 vs. 71 minutes). There was no significant difference in primary composite endpoint between the 2 groups (onsite 3.8% vs. transfer 5.3%, odds ratio 1.50, 95% confidence interval 0.79-2.84; P = 0.21). Adjusted risk estimates did not show a statistical difference in all-cause bleeding rates between the groups (onsite 10.1% vs. transfer 7.3%, odds ratio 0.68, 95% confidence interval 0.41-1.14; P = 0.14). CONCLUSIONS: This study confirms that well-established and integrated regional STEMI programs provide equivalent care to transferred patients and onsite patients. Parameters beyond door to balloon times should be investigated for their contributions to improve patient outcomes.
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Mallidi et al. (2018) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=1,236). Transfer from a non-PCI facility vs. Direct onsite presentation to the primary PCI center was evaluated on Composite of in-hospital major cardiovascular events (death, myocardial infarction, and stroke) (OR 1.50, 95% CI 0.79-2.84, p=0.21). Transfer for primary PCI was not associated with a significant difference in in-hospital major cardiovascular events compared to direct onsite presentation.
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