[Transfer of patients with acute coronary syndromes]

The creation of a network to treat patients with acute coronary syndrome with revascularization devices presents a series of critical issues, one of which is the transfer of this type of patients from a spoke to a hub hospital with angioplasty facilities. We investigated the means of transport and the adverse events that could occur during such transfers.

We analyzed data relating to patients moved from our spoke hospital to hubs over a period of 2 years, utilizing medical records and transport reports.

During this period, 531 patients aged 30-91 years were moved; complete clinical data and transfer reports were available for 495 (93%). There were 42 patients with a diagnosis of ST-elevation myocardial infarction (STEMI) <24 h; 115 with STEMI >24 h; 33 with non-ST-elevation myocardial infarction (NSTEMI) <24 h; 156 with NSTEMI >24 h; 122 with unstable angina; and 27 with other diseases. Of these patients, 157 had angina in the 24 h before the transfer; 24 had signs of hemodynamic instability; and 18 had electrical instability, for a total of 166 "unstable patients"; 294 patients (59%) were moved in a medically equipped ambulance with a cardiologist and a professional nurse on board. There were three adverse events (< 1%) but no deaths: one cardiac arrest, one acute pulmonary edema, and one relapse of myocardial infarction. All 3 patients showed signs of clinical and hemodynamic instability at the time of transfer.

The transfer from spoke to hub of patients with acute coronary syndrome who need coronary angiography can be done easily and safely, with a low incidence of adverse events, which are correlated with preexisting clinical and hemodynamic instability.