Comparison of clinical outcomes between direct and indirect transfer in patients with ST-segment elevation myocardial
Yoshiaki Hai1, Kenichi Sakakura2, Hiroyuki Jinnouchi1
1Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
Insights
Direct ambulance transport to a primary percutaneous coronary intervention (PCI) facility for ST-segment elevation myocardial infarction (STEMI) is not superior to indirect transfer for major adverse cardiovascular events (MACE) in patients with a choice.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Primary percutaneous coronary intervention (PCI) is the standard treatment for ST-segment elevation myocardial infarction (STEMI).
- Prior research suggested direct ambulance transport to PCI facilities improves outcomes, but often included critically ill patients.
- The optimal transport strategy for STEMI patients with transport choices remains unclear.
Purpose of the Study:
- To compare clinical outcomes between direct ambulance transport and indirect transfer (via primary care physician) in STEMI patients who had a choice.
- To determine if indirect transfer is associated with increased major adverse cardiovascular events (MACE).
Main Methods:
- A cohort study of 462 STEMI patients who could choose between direct or indirect transport.
- Primary endpoint: Major Adverse Cardiovascular Events (MACE), a composite of death, non-fatal MI, heart failure re-admission, and target vessel revascularization.
- Follow-up duration: Median 540 days. Statistical analysis adjusted for confounders.
Main Results:
- Direct transport group had a significantly shorter onset-to-balloon time.
- No significant difference in MACE rates between direct (31.4%) and indirect (27.2%) transfer groups (p=0.330).
- Indirect transfer was not associated with MACE after adjusting for confounders (aHR=0.740, p=0.161).
Conclusions:
- For STEMI patients with the option to choose, indirect transfer via primary care physician is not associated with worse clinical outcomes compared to direct ambulance transport.
- These findings challenge the universal recommendation for direct transport when patient choice is possible.
Abstract:
Primary percutaneous coronary intervention (PCI) is the cornerstone of treatment for ST-segment elevation myocardial infarction (STEMI). Previous studies suggest that direct transport by ambulance to a primary PCI facility is associated with better clinical outcomes in patients with STEMI. However, those studies included seriously ill patients for whom direct transport is the only option. We included 462 patients with STEMI who were supposed to select either direct transport by ambulance or indirect transport via primary care doctor, and compared the clinical outcomes between the direct transfer group (n = 172) and the indirect transfer group (n = 290). The primary endpoint was major adverse cardiovascular events (MACE), which was defined as the composite of all-cause death, non-fatal myocardial infarction, re-admission for heart failure, and target vessel revascularization. The median follow-up duration was 540 days (86-1266 days). Age was significantly higher in the indirect transfer group [72.0 (64-80) years] than in the direct transfer group [69.5 (58.3-77) years] (p = 0.013). Onset to balloon time was significantly shorter in the direct transport group (p < 0.001). The Kaplan-Meier curves revealed that MACE were similarly observed between the two groups (31.4% vs. 27.2%; p = 0.330). After adjusting for potential confounders, indirect transfer was not associated with MACE (adjusted hazard ratio: 0.740, 95% confidence interval: 0.485-1.128, p = 0.161). In conclusion, indirect transfer was not associated with poor clinical outcomes in patients with STEMI who were supposed to select either direct transport or indirect transport.
More Related Videos
04:41Digital PCR for Quantifying Circulating MicroRNAs in Acute Myocardial Infarction and Cardiovascular Disease
Published on: July 3, 2018
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
01:22Mitral Stenosis I: Introduction
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies