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Patients with ST-segment Elevation Myocardial Infarction who were transferred from non-PCI capable facility tend to have worse clinical outcomes compared to those who directly arrived at PCI capable facility from the field. Patients with non-ST-segment Elevation Myocardial Infarction (NSTEMI) may initially present to non-PCI facility. The aim of the present study is to elucidate the clinical and angiographic characteristics and in-hospital outcome of NSTEMI patients transferred to our facility from non-PCI capable facility.
We performed a retrospective analysis of consecutive patients presenting with NSTEMI who underwent coronary angiography from January 2013 to June 2014 at our facility. Patients were categorized into following two groups; 1) transfer from non-PCI capable facility and 2) direct arrival to our facility. Baseline, laboratory, and angiographic characteristics were recorded. In addition, in-hospital revascularization procedure and mortality were recorded and compared between the two groups.
After excluding 6 patients with insufficient data, a total 475 patients were included in the final analysis, of which 107 patients (22.5%) were transferred from non-PCI capable facility. Patients who directly arrived at our facility had a higher rate of history of myocardial infarction (MI) (19.0% vs. 10.3%, p=0.034) compared to those who were transferred from non-PCI capable facility. Patients who were transferred from non-PCI capable facility had a higher peak troponin I value (2.02 [0.28-8.35] ng/ml vs. 0.45 [0.09-4.55] ng/ml, p<0.001) and a higher rate of multi-vessel disease (65.4% vs. 48.6%, p=0.002) than patients who directly arrived at our facility. In addition, patients who were transferred from non-PCI capable facility were more likely to undergo in-hospital coronary artery bypass grafting (CABG) (14.0% vs. 7.6%, p=0.042) compared to patients who directly arrived at our facility. No significant difference was observed in in-hospital mortality (0.9% vs. 1.6%, p=0.60) between the two groups.
In our cohort of NSTEMI patients undergoing coronary angiography, 22.5% of patients were transferred from non-PCI capable facility. Patients transferred from non-PCI capable facility were less likely to have a history of MI, but had a higher peak troponin I value. Furthermore, those patients were more likely to have multi-vessel disease and in-hospital CABG.