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Transfer distance effect on reperfusion: timeline of ST-elevation patients transferred for primary percutaneous
Sa'ar Minha1, Joshua P Loh1, Lowell F Satler1
1MedStar Washington Hospital Center, Washington, DC, USA.
Insights
Regional STEMI care networks ensure comparable outcomes for heart attack patients regardless of transfer distance. This system effectively reduces door-to-balloon times, proving distance is not a barrier to timely treatment.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Systems Research
Background:
- Regional emergency care systems aim to expedite reperfusion for ST-elevation myocardial infarction (STEMI) patients.
- The impact of transfer distance on STEMI patient outcomes within these systems requires further investigation.
Purpose of the Study:
- To determine if transfer distance affects outcomes for STEMI patients undergoing percutaneous coronary intervention (PCI).
Main Methods:
- Comparison of STEMI patient characteristics and outcomes based on transfer distance (>25 miles vs. ≤25 miles).
- Utilized data from a regional STEMI care network in the Washington DC metropolitan area.
- Analyzed door-to-balloon (DTB) times and in-hospital mortality.
Main Results:
- No significant difference in median DTB times between patients transferred from >25 miles (158 min) and ≤25 miles (149 min).
- In-hospital mortality rates were similar for both groups (8% vs. 7.2%).
- The regional STEMI network demonstrated a consistent reduction in DTB times over its operational years.
Conclusions:
- A regional STEMI care network effectively minimizes the impact of transfer distance on DTB times for patients initially presenting to non-PCI capable centers.
- Comparable patient outcomes are achievable irrespective of transfer distance within a well-established STEMI network.
Objectives:
This study aims to establish if transfer distance impacts the outcome of ST-elevation myocardial infarction (STEMI) patients transferred to a percutaneous coronary intervention (PCI).
Background:
Regional emergency care systems were designed to decrease delays in reperfusion of patients but the effect of transfer distance on outcome is less established.
Methods:
We compare the characteristics and outcomes of STEMI patients transferred from a distance >25 miles (GT25) to those transferred from distances ≤25 miles (LT25) by utilizing data from a regional STEMI care network in the greater Washington DC area.
Results:
Within the transferred patients (n=1065), 609 patients (57%) were transferred from GT25 (median distance 36 miles), while 456 (43%) were transferred from LT25 (median distance 13 miles). Most of the baseline characteristics between the groups were similar. Door-to-balloon (DTB) was defined as the time elapsed from the presentation to the center without PCI capability to flow restoration in the culprit artery. No differences were noted in the median DTB (GT25: 158min [122-213] vs. 149 [118-219]; p=0.5) or in in-hospital mortality (8% vs. 7.2%; p=0.617). By implementing the regional STEMI care network, a constant decrease in DTB was noted throughout its years of operation.
Conclusions:
For STEMI patients presenting to a non-PCI capable center, a network care system for PCI mitigates the distance factor on DTB time. This is turn translates into comparable outcomes.
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