Key result
Direct PPCI transfer after OHCA is linked to ~32% lower 3-year mortality versus indirect transfer.
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?
Cohort (n=613)
Yes
Does direct transfer to a PPCI centre improve survival in adults with OHCA and ST-elevation compared to indirect transfer?
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.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“[The] findings support ongoing efforts to optimise regional pathways for OHCA management, while recognising the need for careful patient selection and further prospective evaluation.”
Direct transfer associated with lower OHCA mortality; hypothesis-generating and requires randomized confirmation before practice change.
Objective Myocardial infarction is a leading cause of out-of-hospital cardiac arrest (OHCA). In patients with OHCA due to suspected acute coronary occlusion, direct transfer to a centre capable of primary percutaneous coronary intervention (PPCI) has been shown to improve short-term outcomes. However, practice remains heterogeneous and the impact on longer-term survival is unclear. We evaluated whether direct transfer of OHCA patients with ST-elevation was associated with improved short-term, medium-term and long-term survival compared with indirect transfer via a non-PPCI hospital. Methods This retrospective cohort study collected data from a national myocardial infarction registry within a regional emergency service network. Adults with OHCA, return of spontaneous circulation and ST-elevation on post-arrest ECG were included between April 2015 and September 2022. Patients were categorised according to direct transfer to a PPCI centre or indirect transfer via a non-PPCI hospital. The primary outcome was all-cause mortality at 3 years, with landmark analyses at 30 days and 1 year. Survival was analysed using adjusted FPSMs, with covariates including age, sex, witnessed event, presenting rhythm and time to emergency response. Results 613 patients were included; 359 (59%) were transferred directly and 254 (41%) indirectly. Call-to-balloon time was shorter following direct transfer (134 min vs 222 min) and survival to discharge was higher (81% vs 68%). Following adjustment, indirect transfer was associated with higher mortality at 30 days (adjusted HR 2.48, 95% CI 1.08 to 5.73), with excess risk attenuating thereafter and stabilising after approximately 6 months. Cumulative incidence of death at 3 years was 27.9% versus 41.3%, an absolute risk difference of 13.5%. Conclusion In patients with OHCA and ST-elevation, direct transfer to PPCI centres was associated with improved survival up to 3 years. This advantage appears driven predominantly by early in-hospital outcomes, supporting direct triage for rapid reperfusion and optimised post-resuscitation care.
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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%).
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