Impact of geographic distance on outcomes among patients undergoing rescue percutaneous coronary intervention for ST-elevation myocardial infarction

Background Many ST-segment elevation myocardial infarction (STEMI) patients rely on thrombolysis where a cardiac catheterization laboratory is not in close proximity. Here, we aimed to evaluate the impact of transfer distance on outcomes in patients who required rescue percutaneous coronary intervention (RPCI) at a single tertiary centre. Methods This study included all RPCI patients presenting to the New Brunswick Heart Centre (NBHC) between 2019 and 2024. Patients were stratified into tertiles of distance between the NBHC and the referring hospital. The primary outcome was a composite of cardiac surgery, post-catheterization vasoactive support, and mechanical circulatory support during the admission. Secondary outcomes were in-hospital mortality, one-year mortality, and one-year all cause readmission. Outcomes were assessed using Kaplan-Meier survival analysis and multivariable logistic regression. Results A total of 995 RPCI patients (74.7% male, mean age 62.9 ± 11.7 years) were identified. Tertile boundaries were < 121 km (T1; n=275), 151-284 km (T2; n=420), 287-445 km, (T3, n=300). Adjusted odds of the primary outcome was comparable between groups (T2 aOR=0.88 [0.51, 1.54], T3 aOR=0.72 [0.39, 1.32]) . Compared to T1 in-hospital mortality (T1, 9.8%; T2, 6.7%; T3, 4.7%, p=0.11) and one-year mortality (p=0.87) were similar between groups; however, transfer distance was associated with higher adjusted odds of one-year hospital readmission (T2 aOR 1.93 [1.26, 2.99]; T3 aOR 1.89 [1.10, 3.23]). Conclusions While acute RPCI outcomes were comparable in this population, transfer distance was associated with one-year hospital readmission, identifying a potential gap in post-discharge care.