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January 18, 2016Cardiology JournalOpen Access

Transferring STEMI patients to PCI centers shows no difference in 1-year MACE versus direct arrival.

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Why the study?

Primary PCI is recommended for STEMI patients even when transfer to a PCI-capable hospital is required, but the impact of transfer on long-term clinical outcomes remains unclear.

Does transferring STEMI patients to PCI-capable hospitals affect the composite of MACE at 1 year compared to direct arrival?

Population

3,576 STEMI patients with less than 12 h symptom onset-to-door time from Korea Acute Myocardial Infarction Registry

Comparison

Transfer to PCI-capable hospital vs direct arrival to PCI-capable hospital

Design

Observational cohort study

Follow-up

1 year

Key result

Transferring patients with ST-segment elevation myocardial infarction to PCI-capable hospitals did not significantly affect the 1-year rate of major adverse cardiac events compared to direct arrival (13.7% vs. 13.9%, p=0.922).

Authors

BKBo Won KimKSKwang SooMPMin Joung Park

Discussion

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Member takes

Overview

Transfer delays yielded similar 1-year MACE in this registry; leaves open whether networks can safely prioritize primary PCI over on-site options.

Study Design

Type

Observational (n=3,576)

Multicenter

Yes

Structured PICO

Does transferring STEMI patients to PCI-capable hospitals affect the composite of MACE at 1 year compared to direct arrival?

P
Population
3,576 patients with ST-segment elevation myocardial infarction and less than 12 hours from symptom onset to door, followed for 1 year.
E
Exposure
Transfer to a PCI-capable hospital for primary PCI
C
Comparator
Direct arrival to a PCI-capable hospital for primary PCI
O
Outcome
Composite of major adverse cardiac event (MACE), defined as death, non-fatal myocardial infarction, and revascularization at 1 yearcomposite

Main Result

Absolute Event Rate: 13.7% vs 13.9%

p-value: p=0.922

Transferring STEMI patients to PCI-capable hospitals, despite time delays, results in similar 1-year clinical outcomes compared to direct arrival.

Limitations

  • Observational study design with significant differences in baseline and angiographic characteristics between groups
  • Survival bias due to lack of data on patients who died at home or during transport to the hospital
  • Follow-up was limited to 1-year clinical outcomes

Cite This Study

Kim et al. (2016) conducted an observational in ST-segment elevation myocardial infarction (n=3,576). Transfer to PCI-capable hospital vs. Direct arrival to PCI-capable hospital was evaluated on Composite of major adverse cardiac event (MACE), defined as death, non-fatal myocardial infarction, and revascularization at 1 year (p=0.922). Transferring patients with ST-segment elevation myocardial infarction to PCI-capable hospitals did not significantly affect the 1-year rate of major adverse cardiac events compared to direct arrival (13.7% vs. 13.9%, p=0.922).

synapsesocial.com/papers/6aaa3a5847961702446cb26ehttps://doi.org/10.5603/cj.a2016.0003
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Also Consider

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

  1. 1Clinical Outcomes of Transferred Versus Onsite Primary Percutaneous Coronary Intervention for Patients With STEMI: Time to Look Beyond Door to Balloon Time2018 · 1 citations
  2. 2Prehospital Transfer Pathway and Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention2015 · 21 citations
  3. 3Nationwide Analysis of Patients With ST-Segment–Elevation Myocardial Infarction Transferred for Primary Percutaneous Intervention2015 · 60 citations
  4. 4Interhospital Transfer versus Direct Admission in Patients with Acute ST-Segment Elevation Myocardial Infarction2020 · 2 citations
  5. 5Outcome of inter-hospital transfer versus direct admission for primary percutaneous coronary intervention: An observational study of 25,315 patients with ST-elevation myocardial infarction from the London Heart Attack Group2020 · 29 citations