What does this research mean for the field?

Transferring STEMI patients from non-PCI-capable hospitals to enhanced community PCI-capable hospitals achieves significantly shorter door-to-balloon times than transfer to quaternary centers without differences in major adverse cardiac events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine whether transferring patients with ST-segment elevation myocardial infarction to PCI-capable enhanced community hospitals provides noninferior outcomes compared to quaternary centers.

September 19, 2026JACC Case ReportsOpen Access

STEMI transfers to enhanced community hospitals link to ~11 minutes shorter door-to-balloon times versus quaternary centers.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: ST-segment elevation myocardial infarction (STEMI) (n=54). Intervention: Transfer to enhanced community (EC) hospital with PCI capability vs. Transfer to quaternary center. Primary outcome: First door-to-balloon time (p=<0.0001 for noninferiority, 0.03 for superiority).

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Why the study?

The optimal transfer destination for STEMI patients presenting to non-PCI-capable hospitals remains unclear, especially when both enhanced community hospitals and quaternary centers with PCI capability are available.

Does transfer to an enhanced community PCI-capable hospital improve door-to-balloon times in STEMI patients compared to transfer to a quaternary center?

Population

54 consecutive STEMI patients presenting to a non-PCI-capable community hospital

Comparison

Transfer to enhanced community PCI-capable hospitals vs transfer to quaternary centers

Design

Retrospective before-after quality improvement noninferiority analysis

Key result

Transferring STEMI patients to an enhanced community hospital yielded noninferior and significantly shorter door-to-balloon times than quaternary centers (90.8 vs 101.6 min; P=0.03).

Authors

IGIan C. Gilchrist ARApril E.P. Read AMAmgad N. Makaryus

Discussion

Member takes

Overview

Supports expedited STEMI transfer to enhanced community hospitals; leaves open prospective confirmation of clinical outcomes.

Key Points

To determine whether transferring patients with ST-segment elevation myocardial infarction to PCI-capable enhanced community hospitals provides noninferior outcomes compared to quaternary centers.
Conducted a retrospective before-after quality improvement noninferiority analysis of 54 consecutive patients presenting to a non-PCI-capable community hospital.
Assigned patients to transfer either to an enhanced community hospital with PCI capability (n = 22) or to a quaternary center (n = 32).
Evaluated first door-to-balloon times, requirement for subsequent interfacility transfer, and major adverse cardiac events.
Door-to-balloon time was significantly shorter and met noninferiority criteria in the enhanced community group compared to quaternary centers (90.8 ± 15.5 vs 101.6 ± 18.9 min; P < 0.0001 for noninferiority, P = 0.03 for superiority).
Rates of major adverse cardiac events and the need for secondary hospital transfer were equivalent between both destination tiers.

Study Design

Type

Observational (n=54)

Multicenter

Structured PICO

Does transfer to an enhanced community PCI-capable hospital improve door-to-balloon times in STEMI patients compared to transfer to a quaternary center?

Population

54 consecutive patients with STEMI presenting to a non-PCI-capable community hospital, transferred to either an enhanced community hospital or a quaternary center.

Exposure

Transfer to enhanced community (EC) hospitals with PCI capability (n=22)

Comparator

Transfer to quaternary centers (n=32)

Outcome

First door-to-balloon times, need for subsequent transfer, and major adverse cardiac eventssurrogate

Main Result

Absolute Event Rate: 90.8% vs 101.6%

p-value: p=<0.0001 for noninferiority, 0.03 for superiority

Transferring STEMI patients to nearby enhanced community PCI-capable hospitals rather than quaternary centers enables faster reperfusion without compromising safety.

Cite This Study

Gilchrist et al. (2026) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=54). Transfer to enhanced community (EC) hospital with PCI capability vs. Transfer to quaternary center was evaluated on First door-to-balloon time (p=<0.0001 for noninferiority, 0.03 for superiority). Transferring STEMI patients to an enhanced community hospital yielded noninferior and significantly shorter door-to-balloon times than quaternary centers (90.8 vs 101.6 min; P=0.03).

synapsesocial.com/papers/6aae47640c69660b71ecc658 https://doi.org/10.1016/j.jaccas.2026.109530

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September 19, 2026JACC Case ReportsOpen Access

STEMI transfers to enhanced community hospitals link to ~11 minutes shorter door-to-balloon times versus quaternary centers.

View Full Paper

Ask AI

Bookmark

Why the study?

Does transfer to an enhanced community PCI-capable hospital improve door-to-balloon times in STEMI patients compared to transfer to a quaternary center?

Population

54 consecutive STEMI patients presenting to a non-PCI-capable community hospital

Comparison

Transfer to enhanced community PCI-capable hospitals vs transfer to quaternary centers

Design

Retrospective before-after quality improvement noninferiority analysis

Key result

Transferring STEMI patients to an enhanced community hospital yielded noninferior and significantly shorter door-to-balloon times than quaternary centers (90.8 vs 101.6 min; P=0.03).

Authors

IGIan C. Gilchrist ARApril E.P. Read AMAmgad N. Makaryus

Discussion

Member takes

Overview

Supports expedited STEMI transfer to enhanced community hospitals; leaves open prospective confirmation of clinical outcomes.

Key Points

To determine whether transferring patients with ST-segment elevation myocardial infarction to PCI-capable enhanced community hospitals provides noninferior outcomes compared to quaternary centers.
Conducted a retrospective before-after quality improvement noninferiority analysis of 54 consecutive patients presenting to a non-PCI-capable community hospital.
Assigned patients to transfer either to an enhanced community hospital with PCI capability (n = 22) or to a quaternary center (n = 32).
Evaluated first door-to-balloon times, requirement for subsequent interfacility transfer, and major adverse cardiac events.
Door-to-balloon time was significantly shorter and met noninferiority criteria in the enhanced community group compared to quaternary centers (90.8 ± 15.5 vs 101.6 ± 18.9 min; P < 0.0001 for noninferiority, P = 0.03 for superiority).
Rates of major adverse cardiac events and the need for secondary hospital transfer were equivalent between both destination tiers.

Study Design

Type

Observational (n=54)

Multicenter

Structured PICO

Does transfer to an enhanced community PCI-capable hospital improve door-to-balloon times in STEMI patients compared to transfer to a quaternary center?

Population

54 consecutive patients with STEMI presenting to a non-PCI-capable community hospital, transferred to either an enhanced community hospital or a quaternary center.

Exposure

Transfer to enhanced community (EC) hospitals with PCI capability (n=22)

Comparator

Transfer to quaternary centers (n=32)

Outcome

First door-to-balloon times, need for subsequent transfer, and major adverse cardiac eventssurrogate

Main Result

Absolute Event Rate: 90.8% vs 101.6%

p-value: p=<0.0001 for noninferiority, 0.03 for superiority

Transferring STEMI patients to nearby enhanced community PCI-capable hospitals rather than quaternary centers enables faster reperfusion without compromising safety.

Cite This Study

synapsesocial.com/papers/6aae47640c69660b71ecc658 https://doi.org/10.1016/j.jaccas.2026.109530

Also Consider

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

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