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Assessing the Safety of Early Repatriation for Stable ST-Segment Elevation Myocardial Infarction Patients After
Razi Khan1, Shanjot Brar2, Farshad Hosseini2
1Royal Columbian Hospital, University of British Columbia, New Westminster, British Columbia, Canada.
Insights
Early repatriation of ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI) is safe. This practice allows for patient redistribution to lower-acuity settings without impacting short- or long-term outcomes.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Repatriation of ST-segment elevation myocardial infarction (STEMI) patients following primary percutaneous coronary intervention (PPCI) is a common practice in regional healthcare systems.
- The safety of early repatriation in stable STEMI patients requires further investigation.
Purpose of the Study:
- To evaluate the short- and long-term safety of early patient repatriation after PPCI in stable STEMI patients.
- To compare outcomes between early and non-repatriated patient cohorts.
Main Methods:
- A cohort of 788 stable STEMI patients undergoing PPCI between 2016-2018 was analyzed.
- Co-primary outcomes included death, myocardial infarction, congestive heart failure, and stroke at 30 days and 1 year.
- Logistic regression was used to assess the association between early repatriation and outcomes, including transfer to cardiologist- vs. internist-based care.
Main Results:
- 62% of patients were repatriated early, with similar primary composite and individual outcome rates compared to non-repatriated patients.
- Early repatriation was not an independent predictor of 30-day or 1-year adverse outcomes or mortality.
- Transfer to cardiologist- versus internist-based centers did not independently affect outcomes in repatriated patients.
Conclusions:
- Early repatriation of stable STEMI patients post-PPCI appears safe, with no significant impact on short- or long-term outcomes.
- Transferring patients to internist-based care centers did not negatively affect outcomes compared to cardiology-based centers.
- Early repatriation facilitates the redistribution of stable STEMI patients to lower-acuity settings within regional hospitals.
Background:
Repatriation of ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI) is common in regional health care programs. We examined the short- and long-term safety of early repatriation after PPCI in stable STEMI patients.
Methods:
Consecutive stable STEMI patients undergoing PPCI between 2016 to 2018 in the Fraser Health Authority were included. Outcomes were compared between early and nonrepatriated cohorts. Co-primary outcomes were a composite of death, myocardial infarction, congestive heart failure, and stroke at 30 days and 1 year. Logistic regression analyses were performed to determine association between early repatriation and outcomes, and to assess impact of transfer to cardiologist- vs internist-based care centres.
Results:
A total of 788 patients were included, with 62% being repatriated early. Primary composite and individual outcomes rates were similar between both cohorts. Early repatriation was not an independent predictor of 30-day (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.50-1.72; P = 0.82) or 1-year (OR 1.05, 95% CI 0.67-1.65; P = 0.8) primary outcome, or of 30-day (OR 1.35, 95% CI 0.41-4.47, P = 0.63) or 1-year (OR 1.03, 95% CI 0.44-2.40; P = 0.95) mortality. Among early repatriated patients, transfer to cardiologist- vs internist-based care centres was not an independent factor for 30-day (OR 1.07, 95% CI 0.45-2.54; P = 0.87) or 1-year (OR 1.17, 95% 0.55-2.50, P = 0.69) primary outcome.
Conclusions:
Early repatriation of stable STEMI patients after PPCI appears to be safe based on short- and long-term outcomes, and transfer to internist- vs cardiology-based centres did not affect outcomes. After PPCI, early repatriation allows for redistribution of stable STEMI patients to lower-acuity settings across regional hospitals.
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