Key result
Direct transfer to PPCI after OHCA linked to ~14% higher 3-year survival vs indirect transfer.
Why the study?
Direct transfer of patients with out-of-hospital cardiac arrest and suspected acute coronary occlusion to a primary PCI centre improves short-term outcomes, but practice remains heterogeneous and the impact on longer-term survival was unclear.
Does direct transfer to a primary percutaneous coronary intervention centre improve survival at 30 days, 1 year, and 3 years compared to indirect transfer via a non-PPCI hospital in adults with out-of-hospital cardiac arrest and ST-elevation?
Cohort (n=702)
Yes
Does direct transfer to a primary percutaneous coronary intervention centre improve survival at 30 days, 1 year, and 3 years compared to indirect transfer via a non-PPCI hospital in adults with out-of-hospital cardiac arrest and ST-elevation?
In patients with out-of-hospital cardiac arrest and ST-elevation, direct transfer to a primary PCI centre is associated with shorter call-to-balloon times and improved survival up to 3 years compared with indirect transfer.
Direct transfer after OHCA with ST-elevation was associated with higher survival; extends prior observational data but requires randomized confirmation before practice change.
Background Myocardial infarction is a leading cause of out-of-hospital cardiac arrest (OHCA). In select 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. Purpose To evaluate whether direct transfer of OHCA patients with ST-elevation to a PPCI centre is associated with improved long-term survival compared with indirect transfer from hospitals without a PPCI service. 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 June 2022. Patients were categorised according to direct transfer to a PPCI centre or indirect transfer via a non-PPCI hospital. The primary outcome was survival at 30 days, 1 year and 3 years. Survival was analysed using adjusted flexible parametric survival models. Covariates included age, sex, witnessed event, presenting rhythm and time to emergency service response. Results A total of 702 patients were included; 415 (59%) were transferred directly and 287 (41%) indirectly. Call-to-balloon time was shorter following direct transfer (153 vs. 245 mins; p<0.001). Survival to discharge was higher in the direct group (79% vs. 68%, p<0.001). Following adjustment for covariates, direct transfer was associated with higher survival at 30 days (risk ratio 1.10, 95% confidence interval 1.07-1.13), 1 year (1.12, 1.09-1.16) and 3 years (1.14, 1.10-1.19). Conclusions In patients with OHCA and ST-elevation, direct transfer to PPCI centres was associated with improved survival up to three years. This survival advantage appears to be driven predominantly by early in-hospital outcomes, supporting direct triage to PPCI centres for rapid reperfusion and optimised post-resuscitation care.
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Darnley et al. (2026) conducted a cohort in Out-of-hospital cardiac arrest with ST-elevation (n=702). Direct transfer to a primary percutaneous coronary intervention (PPCI) centre vs. Indirect transfer via a non-PPCI hospital was evaluated on Survival at 30 days, 1 year, and 3 years (reported below at 3 years) (RR 1.14, 95% CI 1.10-1.19). Direct transfer to a PPCI centre after OHCA with ST-elevation increased survival vs indirect transfer at 30 days (RR 1.10; 95% CI 1.07-1.13) and 3 years (RR 1.14; 95% CI 1.10-1.19).
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