Related Experiment Video

Updated: Jul 29, 2025

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

24.3K

Interhospital Transfer versus Direct Admission in Patients with Acute ST-Segment Elevation Myocardial Infarction

Surya Dharma1, Iwan Dakota2, Hananto Andriantoro2

  • 1Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia.

The International Journal of Angiology : Official Publication of the International College of Angiology, Inc
|May 19, 2023
PubMed

Insights

Interhospital transfer for ST-elevation myocardial infarction (STEMI) patients leads to longer total ischemic time despite faster reperfusion. Delays in initial hospital care (door-in-to-door-out time) significantly prolong treatment times.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Emergency Medicine

Background:

  • ST-segment elevation myocardial infarction (STEMI) requires timely reperfusion therapy.
  • Interhospital transfer is a common pathway for STEMI patients to access primary percutaneous coronary intervention (PCI) centers.
  • Concerns exist regarding potential delays in reperfusion associated with interhospital transfers.

Purpose of the Study:

  • To evaluate reperfusion delays in STEMI patients admitted via interhospital transfer versus direct admission to a primary PCI center.
  • To compare door-to-device (DTD) times and total ischemic times between the two patient groups.

Main Methods:

  • Retrospective analysis of 6,494 STEMI patients admitted between 2011 and 2019.
  • Comparison of demographic and clinical characteristics, admission pathways, and reperfusion times.
  • Logistic regression analysis to identify factors associated with prolonged ischemic time in transferred patients.

Main Results:

  • Interhospital transferred patients had longer symptom-to-PCI center admission times (360 vs. 300 minutes) and total ischemic times (465 vs. 414 minutes).
  • Transferred patients received primary PCI more frequently and had shorter DTD times (74 vs. 87 minutes).
  • Delay in door-in-to-door-out (DI-DO) time at the referring hospital was strongly associated with prolonged total ischemic time (aOR=3.92).

Conclusions:

  • While interhospital transfer facilitates access to primary PCI with shorter DTD times, it is associated with increased total ischemic time.
  • Delays in DI-DO time at the initial referring hospital are a critical factor contributing to prolonged ischemic times in STEMI patients.
  • Improving DI-DO efficiency at referring hospitals is crucial to reduce overall ischemic burden in STEMI patients undergoing interhospital transfer.

Keywords:
STEMIdirect admissioninterhospital transferreperfusion delay

More Related Videos

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

12.1K
Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control05:41

Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control

Published on: December 16, 2022

3.5K

Related Concept Videos

Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
33
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
15
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
24
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
12
Introduction Cardiac Emergencies01:30

Introduction Cardiac Emergencies

Cardiac emergencies are critical situations involving the heart that require immediate medical intervention to prevent severe complications or death. These emergencies often arise from underlying heart conditions that impair the heart's ability to function correctly.Types of Cardiac EmergenciesThe most common types of cardiac emergencies include Acute Coronary Syndrome (ACS), myocardial infarction (MI), cardiac arrest, and heart failure.Acute Coronary Syndrome (ACS)Acute Coronary Syndrome (ACS)...
37
Myocarditis II: Clinical Features and Diagnostic Tests01:27

Myocarditis II: Clinical Features and Diagnostic Tests

Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
12