Key result
Transferring STEMI patients for primary PCI after out-of-hospital CPR yields similar in-hospital survival to direct admission.
Why the study?
Does interhospital transfer for primary PCI affect in-hospital mortality in STEMI patients after successful out-of-hospital CPR compared to direct admission to a PCI center?
Cohort (n=44)
Yes
Does interhospital transfer for primary PCI affect in-hospital mortality in STEMI patients after successful out-of-hospital CPR compared to direct admission to a PCI center?
Absolute Event Rate: 44% vs 54%
p-value: p=0.76
Transferring STEMI patients after successful out-of-hospital CPR to a PCI-capable center does not significantly worsen in-hospital mortality compared to direct admission, supporting the strategy of transferring these patients for primary PCI.
Interhospital transfer was associated with comparable survival; leaves open whether randomized trials would support routine transfer for post-CPR STEMI.
OBJECTIVE: To evaluate the impact of transfer from a referral hospital to a center with primary percutaneous coronary intervention (PCI) facilities of ST-segment elevation myocardial infarction (STEMI) patients after successful cardiopulmonary resuscitation (CPR). METHODS: We studied all STEMI patients with successful CPR admitted to two centers after out-of-hospital cardiac arrest and CPR from January 2004 to December 2005. Subjects were divided in a transferred (PCI performed after referral from center without PCI facility) and nontransferred (PCI performed in hospital of admission, i.e. center with PCI facility) group. RESULTS: A total of 44 patients were included. Mean age was 61 +/- 13 year and 35 (80%) patients were male. Of all patients 16 (36%) were transferred for treatment. After treatment, the left ventricular function was preserved in 4 (25%) patients of the transferred group are compared with 17 (61%) of the nontransferred group (P = 0.024). In-hospital mortality after follow-up did not differ with 7 (44%) survivors in the transferred group versus 15 (54%) survivors in the nontransferred group (P = 0.76). Patients who did not survive were more often treated with endotracheal intubation (100% versus 71%, P= 0.019), had more often an occlusion of the proximal right coronary artery (37% versus 10%, P= 0.02), and higher glucose levels at admission (15.2 mmol/l +/- 4.4 versus 11.5 mmol/l +/- 4.2, P= 0.009). CONCLUSION: In conclusion, no difference in outcome was observed between nontransferred and transferred patients. Therefore, we suggest that transfer for primary PCI for STEMI patients after successful CPR should be considered.
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Peels et al. (2008) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) after out-of-hospital cardiac arrest (n=44). Transfer to a center with primary PCI facilities vs. Nontransferred (direct admission to a center with PCI facilities) was evaluated on In-hospital survival (p=0.76). Transferring STEMI patients to a primary PCI center after successful out-of-hospital CPR resulted in similar in-hospital survival compared to direct admission (44% vs 54%; P=0.76).
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