Direct Admission Versus Interhospital Transfer for Primary Percutaneous Coronary Intervention in ST-Segment Elevation
Damian Kawecki1, Marek Gierlotka2, Beata Morawiec1
12nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.
Insights
Direct admission for ST-segment elevation myocardial infarction (STEMI) patients to a percutaneous coronary intervention (PCI) center reduces time delays and 12-month mortality compared to interhospital transfer. This approach should be preferred for better patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Reducing reperfusion delays is critical for ST-segment elevation myocardial infarction (STEMI) patient care.
- The comparative effectiveness of direct admission versus interhospital transfer to percutaneous coronary intervention (PCI) centers on long-term outcomes remains debated.
- Direct admission is hypothesized to improve outcomes by shortening ischemic time and preserving left ventricular function.
Purpose of the Study:
- To evaluate the impact of direct admission versus interhospital transfer to a PCI center on time delays and 12-month mortality in STEMI patients.
- To assess the real-world effectiveness of different STEMI patient pathways on clinical outcomes.
- To determine if direct admission is superior to interhospital transfer for STEMI patients undergoing PCI.
Main Methods:
- Analysis of prospective nationwide registry data of STEMI patients treated with PCI between 2006 and 2013.
- Comparison of patients directly admitted to PCI centers versus those transferred from regional non-PCI-capable facilities.
- Adjustment for confounding factors using propensity-matched and multivariate Cox analyses to assess time delays, left ventricular ejection fraction (LVEF), and 12-month mortality.
Main Results:
- Direct admission (56% of 70,093 patients) was associated with significantly shorter symptom-to-admission time (44 min reduction) and total ischemic time (228 vs. 270 min).
- Patients directly admitted had higher left ventricular ejection fraction (LVEF) and lower propensity-matched 12-month mortality (9.6% vs. 10.4%).
- Direct admission and shorter symptom-to-admission times were independent predictors of reduced 12-month mortality in multivariate analysis.
Conclusions:
- Direct admission to a primary PCI center is associated with improved outcomes, including lower 12-month mortality, in STEMI patients treated with PCI.
- Transfer via a regional non-PCI-capable facility should be avoided in favor of direct admission when possible for STEMI patients.
- Optimizing STEMI care pathways through direct admission can significantly improve survival rates.
Objectives:
This study sought to assess the influence of direct admission versus transfer via regional hospital to a percutaneous coronary intervention (PCI) center on time delays and 12-month mortality in ST-segment elevation myocardial infarction (STEMI) patients from a real-life perspective.
Background:
Reduction of delays to reperfusion is crucial in a STEMI system of care. However, it is still debated whether direct admission to a PCI center is superior to interhospital transfer in terms of long-term prognosis. The authors hypothesized that compared with interhospital transfer, direct admission shortens the total ischemic time, limits the loss of left ventricular systolic function, and finally, reduces 12-month mortality.
Methods:
Prospective nationwide registry data of STEMI patients admitted to PCI centers within 12 h of symptom onset and treated with PCI between 2006 and 2013 were analyzed. Patients admitted directly were compared with patients transferred to a PCI center via a regional non-PCI-capable facility in terms of time delays, left ventricular ejection fraction (LVEF), and 12-month mortality. Data were adjusted using propensity-matched and multivariate Cox analyses.
Results:
Of the 70,093 patients eligible for analysis, 39,144 (56%) were admitted directly to a PCI center. Direct admission was associated with a shorter median symptoms-to-admission time (by 44 min; p < 0.001) and total ischemic time (228 vs. 270 min; p < 0.001), higher LVEF (47.5% vs. 46.3%; p < 0.001), and lower propensity-matched 12-month mortality (9.6% vs. 10.4%; p < 0.001). In propensity-matched multivariate Cox analysis, direct admission (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01 to 1.11) and shorter symptoms-to-admission time (HR: 1.03; 95% CI: 1.01 to 1.06) were significant predictors of lower 12-month mortality.
Conclusions:
In a large, community-based cohort of patients with STEMI treated by PCI, direct admission to a primary PCI center was associated with lower 12-month mortality and should be preferred to transfer via a regional non-PCI-capable facility.
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