Inter-Facility Transfer vs. Direct Admission of Patients With ST-Segment Elevation Acute Myocardial Infarction
Kenji Nakatsuma1, Hiroki Shiomi, Takeshi Morimoto
1Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Insights
Inter-facility transfer for ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) is linked to worse long-term outcomes. This delay in treatment increases the risk of death or heart failure hospitalization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- Inter-facility transfer for primary PCI delays treatment for STEMI patients.
- Limited data exists on clinical outcomes for STEMI patients transferred between facilities in Japan.
Purpose of the Study:
- To compare the long-term clinical outcomes of STEMI patients undergoing primary PCI via inter-facility transfer versus direct admission to PCI centers in Japan.
Main Methods:
- Analysis of the CREDO-Kyoto AMI registry data from 3,820 STEMI patients undergoing primary PCI within 24 hours of symptom onset.
- Comparison of 5-year cumulative incidence of all-cause death or heart failure hospitalization between inter-facility transfer and direct admission groups.
- Statistical adjustment for potential confounding factors.
Main Results:
- 45.2% of STEMI patients (1,725) underwent inter-facility transfer; 54.8% (2,095) were directly admitted.
- The 5-year incidence of death/heart failure hospitalization was significantly higher in the transfer group (26.9%) compared to the direct admission group (22.2%).
- Inter-facility transfer remained a significant risk factor for death/heart failure hospitalization (adjusted hazard ratio: 1.22).
Conclusions:
- Inter-facility transfer is associated with significantly worse long-term clinical outcomes for STEMI patients receiving primary PCI.
- Strategies to minimize transfer delays may improve patient outcomes in STEMI care.
Background:
Inter-facility transfer for primary percutaneous coronary intervention (PCI) from referring facilities to PCI centers causes a significant delay in treatment of ST-segment elevation acute myocardial infarction (STEMI) patients undergoing primary PCI. However, little is known about the clinical outcomes of STEMI patients undergoing inter-facility transfer in Japan.
Methods And Results:
In the CREDO-Kyoto acute myocardial infarction (AMI) registry that enrolled 5,429 consecutive AMI patients in 26 centers in Japan, the current study population consisted of 3,820 STEMI patients who underwent primary PCI within 24 h of symptom onset. We compared long-term clinical outcomes between inter-facility transfer patients and those directly admitted to PCI centers. The primary outcome measure was a composite of all-cause death or heart failure (HF) hospitalization. There were 1,725 (45.2%) inter-facility transfer patients, and 2,095 patients (54.8%) with direct admission to PCI centers. The cumulative 5-year incidence of death/HF hospitalization was significantly higher in the inter-facility transfer patients than in those with direct admission (26.9% vs. 22.2%; log-rank P<0.001). After adjusting for potential confounders, the risk for death/HF hospitalization was significantly higher (adjusted hazard ratio: 1.22, 95% confidence interval: 1.07-1.40, P<0.001) in the inter-facility transfer patients than in those directly admitted.
Conclusions:
Inter-facility transfer was associated with significantly worse long-term clinical outcomes for patients with STEMI undergoing primary PCI. (Circ J 2016; 80: 1764-1772).
More Related Videos
06:10Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:24Cardiac Catheterization III: Left Heart Catheterization