Safety of returning patients immediately to their originating hospitals after primary percutaneous coronary
Rahim Gul1, Maksymilian P Opolski2, Mufti Akif1
1Department of Cardiology, Prince Sultan Cardiac Center Qassim (PSCCQ), Burayda, Qassim, Saudi Arabia.
Insights
Patients with ST-elevation myocardial infarction (STEMI) can safely return to their original hospitals after primary percutaneous coronary intervention (PPCI). This strategy is feasible and effective for reperfusion therapy, showing no increased adverse events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- ST-elevation myocardial infarction (STEMI) requires timely reperfusion therapy.
- Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy.
- Transferring STEMI patients to specialized centers for PPCI and subsequent return to originating hospitals is a common practice.
Purpose of the Study:
- To evaluate the safety and feasibility of immediate patient return to originating hospitals post-PPCI for STEMI.
- To compare adverse cardiovascular events (ACEs) between patients returning to originating hospitals and those treated onsite.
Main Methods:
- Prospective study conducted from January 2014 to December 2017.
- Included STEMI patients transferred for PPCI and returned to referring hospitals (RB group) compared to onsite STEMI population (OS group).
- Recorded demographics, PPCI data, bleeding, and ACEs during transfer, hospital stay, and at 1-month follow-up.
Main Results:
- 350 patients in the RB group were compared to 156 patients in the OS group.
- Longer times to treatment were observed in the RB group (first medical contact to balloon: 110 ± 67 min vs. 46 ± 35 min; symptom onset to balloon: 366 ± 300 min vs. 312 ± 120 min).
- No significant differences in in-hospital or 30-day ACEs (death, reinfarction, bleeding, repeat revascularization) were found between the RB and OS groups.
Conclusions:
- Immediate return of non-complicated STEMI patients to their referring hospitals after PPCI is safe and feasible.
- This approach can be integrated into effective reperfusion strategies for STEMI.
- The study supports the continued use of this model in STEMI management.
Introduction:
The objective of this study was to evaluate the safety and feasibility of the immediate return of patients with ST-elevation myocardial infarction (STEMI) to their originating hospitals after primary percutaneous coronary intervention (PPCI).
Methods:
This was a prospective study, conducted between January 2014 and December 2017. All patients with STEMI who were transferred for PPCI and returned back to their referring hospitals (RB group) were included and compared to the onsite STEMI population (OS group). Patient's demographics, PPCI data, bleeding and adverse cardiovascular events (ACEs) occurring during transfer, hospital stay, and at 1-month follow-up were recorded.
Results:
A total of 156 patients in the OS group were compared against 350 patients in the RB group. We found that first medical contact to balloon time and onset of symptoms to balloon time were significantly longer in the RB group than in the OS group [110 ± 67 min vs. 46 ± 35 min (p < 0.0001) and 366 ± 300 min vs. 312 ± 120 min (p = 0.04)], respectively. There were no differences between the RB and OS groups in in-hospital ACEs: 0.3% versus 0% (p = 0.8) for death, 0.3% versus 0.6% (p = 0.79) for reinfarction, 0.6% versus 2% (p = 0.72) for bleeding, and no reported cases of repeat revascularization; and 30-day ACEs: 0.3% versus 0.6% (p = 0.82) for death, 0.3% versus 1.2% (p = 0.68) for reinfarction, 0.6% versus 2% (p = 0.74) for bleeding, and 1.1% versus 1.2% (p = 0.9) for repeat revascularization.
Conclusion:
The immediate return of patients with noncomplicated STEMI after PPCI to their referring hospitals is safe and feasible, and can be used as part of an effective reperfusion strategy.
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