In-hospital outcomes of a regional ST-segment elevation myocardial infarction acute transfer and repatriation program
Albert W Chan1, Shahrukh N Bakar, Robert I Brown
1Department of Cardiac Services, Royal Columbian Hospital, New Westminster, British Columbia, Canada. albert.chan@fraserhealth.ca
Insights
A regional STEMI care system with patient transfer to PCI centers is feasible and safe. This approach effectively manages ST-segment elevation myocardial infarction patients across large areas without increasing in-hospital mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is challenging in large geographic areas.
- Achieving treatment time targets and managing PCI center resources are key concerns.
Purpose of the Study:
- To compare in-hospital mortality rates for STEMI patients transferred from 11 hospitals versus those presenting directly to a cardiac center.
- To evaluate a regional STEMI program utilizing a selective repatriation strategy.
Main Methods:
- Prospective collection of clinical and procedural data for STEMI patients referred for PCI (June 2003-June 2007).
- Exclusion of patients with prolonged cardiac arrest.
- Comparison of mortality between transfer patients and direct presenters.
Main Results:
- No significant in-hospital mortality difference between transfer (3.7%) and direct PCI (4.0%) groups (P=0.87).
- Independent mortality predictors included advanced age, female gender, multivessel disease, hypertension, low ejection fraction, and high LVEDP.
- Transfer patients repatriated immediately post-procedure had significantly lower mortality (1.9%) than those admitted to the PCI center (11.5%).
Conclusions:
- A regional STEMI care system using rapid transfer to a PCI center and repatriation is feasible and safe.
- This model effectively addresses logistical challenges in STEMI management over large regions.
Background:
Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) presents challenges in a large geographic area for achieving treatment time targets and creates demands on the PCI centre resources.
Objective:
We compare the in-hospital mortality rate of patients presenting with STEMI and referred for PCI from 11 transfer hospitals with those presenting to the cardiac centre in a regional STEMI program with a selective repatriation strategy.
Methods:
Between June 1, 2003, and June 30, 2007, clinical and procedural data of all STEMI patients who were referred to the catheterization laboratory were prospectively collected. Patients who sustained prolonged cardiac arrest were excluded.
Results:
A total of 1154 patients from regional hospitals and 325 patients initially presenting to the PCI centre were referred for acute intervention. There was no significant in-hospital mortality difference between the 2 groups (3.7% vs 4.0%, respectively; P = 0.87). Multiple logistic regression analysis showed that advanced age, female gender, multivessel coronary disease, history of hypertension, low ejection fraction, increased left ventricular end-diastolic pressure, and thrombolytic pretreatment, but not transfer status, were independent predictors for mortality. Among the 1154 transfer patients, 937 patients (81.2%) returned immediately post procedure and had a lower mortality rate than the remaining 217 patients (18.2%) who required admission to the PCI centre following cardiac catheterization (1.9% vs 11.5%, P < 0.001).
Conclusion:
A regional system of STEMI care based on rapid patient transfer to a PCI centre and repatriation was feasible and safe.
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