Author + information
- Received October 24, 2016
- Accepted November 17, 2016
- Published online March 6, 2017.
- Damian Kawecki, MD, PhDa,∗ (, )
- Marek Gierlotka, MD, PhDb,c,
- Beata Morawiec, MD, PhDa,
- Michał Hawranek, MD, PhDb,c,
- Mateusz Tajstra, MD, PhDb,c,
- Michał Skrzypek, PhDc,d,
- Wojciech Wojakowski, MD, PhDe,
- Lech Poloński, MD, PhDb,c,
- Ewa Nowalany-Kozielska, MD, PhDa and
- Mariusz Gąsior, MD, PhDb,c
- a2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
- b3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
- cDepartment of Science, Training and New Medical Technologies, Silesian Center for Heart Diseases, Zabrze, Poland
- dDepartment of Biostatistics, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
- e3rd Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
- ↵∗Address for correspondence:
Dr. Damian Kawecki, 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland, M. Sklodowskiej-Curie 10, 41-800 Zabrze, Poland.
Objectives This study sought to assess the influence of direct admission versus transfer via regional hospital to a percutaneous coronary intervention (PCI) center on time delays and 12-month mortality in ST-segment elevation myocardial infarction (STEMI) patients from a real-life perspective.
Background Reduction of delays to reperfusion is crucial in a STEMI system of care. However, it is still debated whether direct admission to a PCI center is superior to interhospital transfer in terms of long-term prognosis. The authors hypothesized that compared with interhospital transfer, direct admission shortens the total ischemic time, limits the loss of left ventricular systolic function, and finally, reduces 12-month mortality.
Methods Prospective nationwide registry data of STEMI patients admitted to PCI centers within 12 h of symptom onset and treated with PCI between 2006 and 2013 were analyzed. Patients admitted directly were compared with patients transferred to a PCI center via a regional non–PCI-capable facility in terms of time delays, left ventricular ejection fraction (LVEF), and 12-month mortality. Data were adjusted using propensity-matched and multivariate Cox analyses.
Results Of the 70,093 patients eligible for analysis, 39,144 (56%) were admitted directly to a PCI center. Direct admission was associated with a shorter median symptoms-to-admission time (by 44 min; p < 0.001) and total ischemic time (228 vs. 270 min; p < 0.001), higher LVEF (47.5% vs. 46.3%; p < 0.001), and lower propensity-matched 12-month mortality (9.6% vs. 10.4%; p < 0.001). In propensity-matched multivariate Cox analysis, direct admission (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01 to 1.11) and shorter symptoms-to-admission time (HR: 1.03; 95% CI: 1.01 to 1.06) were significant predictors of lower 12-month mortality.
Conclusions In a large, community-based cohort of patients with STEMI treated by PCI, direct admission to a primary PCI center was associated with lower 12-month mortality and should be preferred to transfer via a regional non–PCI-capable facility.
- 12-month mortality
- acute myocardial infarction
- interhospital transfer
- primary PCI
- STEMI networks
- time delays
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 24, 2016.
- Accepted November 17, 2016.
- American College of Cardiology Foundation