What does this research mean for the field?

Direct transfer to a primary percutaneous coronary intervention (PPCI) center following out-of-hospital cardiac arrest with ST-elevation is associated with lower 3-year mortality compared to indirect transfer. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 8, 2026Heart

Direct transfer to primary percutaneous coronary intervention centres following out-of-hospital cardiac arrest: longer term outcomes and influences on survival

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Out-of-hospital cardiac arrest with ST-elevation (n=613). Intervention: Direct transfer to a primary percutaneous coronary intervention (PPCI) centre vs. Indirect transfer via a non-PPCI hospital. Primary outcome: All-cause mortality at 3 years (Absolute risk difference 13.5%).

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Why the study?

Although direct transfer to PPCI centres improves short-term outcomes in suspected acute coronary occlusion OHCA, practice remains heterogeneous and the impact on longer-term survival is unclear.

Does direct transfer to a PPCI centre improve survival in adults with OHCA and ST-elevation compared to indirect transfer?

Population

613 adults with OHCA, return of spontaneous circulation, and ST-elevation on post-arrest ECG

Comparison

Direct transfer to a PPCI centre vs indirect transfer via a non-PPCI hospital

Design

Retrospective cohort study

Follow-up

3 years

Key result

Direct transfer to a PPCI center following out-of-hospital cardiac arrest was associated with lower 3-year mortality compared to indirect transfer (27.9% vs 41.3%; absolute risk difference 13.5%).

Authors

AHAlexander Hunt DSD. Scholfield JMJoseph Morris

Discussion

Member takes

Overview

Direct transfer associated with lower OHCA mortality; hypothesis-generating and requires randomized confirmation before practice change.

Key Points

To determine whether direct transfer of patients with out-of-hospital cardiac arrest and ST-elevation to primary percutaneous coronary intervention centres improves short-term and long-term survival compared with indirect transfer via non-specialist hospitals.
Analyzed data from a national myocardial infarction registry for 613 adult patients with out-of-hospital cardiac arrest, return of spontaneous circulation, and post-arrest ST-elevation between April 2015 and September 2022.
Categorized patients into direct transfer to a primary percutaneous coronary intervention centre (N=359) or indirect transfer via a non-intervention hospital (N=254).
Evaluated all-cause mortality over a 3-year follow-up period using adjusted flexible parametric survival models with landmark analyses at 30 days and 1 year.
Direct transfer shortened median call-to-balloon time (134 min vs 222 min) and resulted in higher survival to hospital discharge (81% vs 68%).
Indirect transfer was associated with significantly increased 30-day mortality (adjusted HR 2.48, 95% CI 1.08 to 5.73), with excess risk attenuating and stabilizing after approximately 6 months.
Cumulative incidence of death at 3 years was 27.9% in the direct transfer cohort versus 41.3% in the indirect transfer cohort, representing an absolute risk difference of 13.5%.

Study Design

Type

Cohort (n=613)

Multicenter

Yes

Structured PICO

Does direct transfer to a PPCI centre improve survival in adults with OHCA and ST-elevation compared to indirect transfer?

Population

613 adults with out-of-hospital cardiac arrest, return of spontaneous circulation, and ST-elevation, followed for up to 3 years.

Exposure

Direct transfer to a primary percutaneous coronary intervention (PPCI) centre

Comparator

Indirect transfer via a non-PPCI hospital

Outcome

All-cause mortality at 3 yearshard clinical

Main Result

Absolute Risk Reduction: 13.5

Absolute Event Rate: 27.9% vs 41.3%

Absolute Risk Reduction: 13.5%

Direct transfer to PPCI centers for OHCA patients with ST-elevation significantly improves survival up to 3 years compared to indirect transfer, primarily driven by early in-hospital outcomes.

Cite This Study

Hunt et al. (2026) conducted a cohort in Out-of-hospital cardiac arrest with ST-elevation (n=613). Direct transfer to a primary percutaneous coronary intervention (PPCI) centre vs. Indirect transfer via a non-PPCI hospital was evaluated on All-cause mortality at 3 years (Absolute risk difference 13.5%). Direct transfer to a PPCI center following out-of-hospital cardiac arrest was associated with lower 3-year mortality compared to indirect transfer (27.9% vs 41.3%; absolute risk difference 13.5%).

synapsesocial.com/papers/6a9fd7ab58e84d0ff5b467a7 https://doi.org/10.1136/heartjnl-2026-328408

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September 8, 2026Heart

Direct transfer to primary percutaneous coronary intervention centres following out-of-hospital cardiac arrest: longer term outcomes and influences on survival

View Full Paper

Ask AI

Bookmark

Why the study?

Although direct transfer to PPCI centres improves short-term outcomes in suspected acute coronary occlusion OHCA, practice remains heterogeneous and the impact on longer-term survival is unclear.

Does direct transfer to a PPCI centre improve survival in adults with OHCA and ST-elevation compared to indirect transfer?

Population

613 adults with OHCA, return of spontaneous circulation, and ST-elevation on post-arrest ECG

Comparison

Direct transfer to a PPCI centre vs indirect transfer via a non-PPCI hospital

Design

Retrospective cohort study

Follow-up

3 years

Key result

Direct transfer to a PPCI center following out-of-hospital cardiac arrest was associated with lower 3-year mortality compared to indirect transfer (27.9% vs 41.3%; absolute risk difference 13.5%).

Authors

AHAlexander Hunt DSD. Scholfield JMJoseph Morris

Discussion

Member takes

Overview

Direct transfer associated with lower OHCA mortality; hypothesis-generating and requires randomized confirmation before practice change.

Key Points

To determine whether direct transfer of patients with out-of-hospital cardiac arrest and ST-elevation to primary percutaneous coronary intervention centres improves short-term and long-term survival compared with indirect transfer via non-specialist hospitals.
Analyzed data from a national myocardial infarction registry for 613 adult patients with out-of-hospital cardiac arrest, return of spontaneous circulation, and post-arrest ST-elevation between April 2015 and September 2022.
Categorized patients into direct transfer to a primary percutaneous coronary intervention centre (N=359) or indirect transfer via a non-intervention hospital (N=254).
Evaluated all-cause mortality over a 3-year follow-up period using adjusted flexible parametric survival models with landmark analyses at 30 days and 1 year.
Direct transfer shortened median call-to-balloon time (134 min vs 222 min) and resulted in higher survival to hospital discharge (81% vs 68%).
Indirect transfer was associated with significantly increased 30-day mortality (adjusted HR 2.48, 95% CI 1.08 to 5.73), with excess risk attenuating and stabilizing after approximately 6 months.
Cumulative incidence of death at 3 years was 27.9% in the direct transfer cohort versus 41.3% in the indirect transfer cohort, representing an absolute risk difference of 13.5%.

Study Design

Type

Cohort (n=613)

Multicenter

Yes

Structured PICO

Does direct transfer to a PPCI centre improve survival in adults with OHCA and ST-elevation compared to indirect transfer?

Population

613 adults with out-of-hospital cardiac arrest, return of spontaneous circulation, and ST-elevation, followed for up to 3 years.

Exposure

Direct transfer to a primary percutaneous coronary intervention (PPCI) centre

Comparator

Indirect transfer via a non-PPCI hospital

Outcome

All-cause mortality at 3 yearshard clinical

Main Result

Absolute Risk Reduction: 13.5

Absolute Event Rate: 27.9% vs 41.3%

Absolute Risk Reduction: 13.5%

Direct transfer to PPCI centers for OHCA patients with ST-elevation significantly improves survival up to 3 years compared to indirect transfer, primarily driven by early in-hospital outcomes.

Cite This Study

synapsesocial.com/papers/6a9fd7ab58e84d0ff5b467a7 https://doi.org/10.1136/heartjnl-2026-328408

Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

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