Benefits of organized PCI transfer confirmed

5 August 2008

MedWire News: Inter-hospital transfer of patients for primary percutaneous coronary intervention (PCI) results in rapid reperfusion times and "favorable" long- and short-term clinical outcomes within an organized regional framework, say Italian researchers.

Inter-hospital transfer of patients to "hub" centers offering PCI has been advocated to allow more patients to benefit from the procedure. However, the advantage of primary PCI over fibrinolysis depends on timely reperfusion, and transfer times necessarily increase the delay before treatment.

Antonio Manari (Ospedale S Maria Nuova, Reggio Emilia) and colleagues studied 3296 patients with ST-elevation myocardial infarction (STEMI) undergoing PCI, 2444 admitted to hospitals with interventional facilities, and 853 transferred from other hospitals, in the northeastern Italian region of Emilia-Romagna. They explain that "an efficient region-wide system for reperfusion has been established" in the region.

The investigators report in the European Heart Journal that, as expected, patients who were transferred had significantly longer median pain-to-balloon and door-to-balloon delays than patients treated directly at PCI centers, at 218 versus 178 minutes and 112 versus 71 minutes, respectively.

In-hospital mortality was similar for transferred patients and those treated directly on-site, at 7.0% versus 5.4%. And 1-year cardiac mortality was no higher in transferred compared directly treated patients after multivariable adjustment, at a hazard ratio of 0.817.

The investigators point out that door-to-balloon times at the PCI center were significantly shorter for patients transferred from other sites than those initially presenting at the PCI center (36 vs 71 minutes), which they attribute to the catheterization laboratory team being better able to mobilize in time for the transferred patients' arrival.

Manari and colleagues say the findings confirm that PCI can be achieved "even in the real-world" with very short additional time delays (around 40 minutes) that do not translate into a worse outcome compared with on-site PCI.

In an accompanying editorial, Arnoud van 't Hof (Isala Klinieken, Zwolle, The Netherlands) congratulated Manari and team on their findings, "the result of careful registration of data and a process of continuous quality improvement with participation of all people involved in the network," and highlighted that reperfusion time can also be shortened further by pre-hospital STEMI triage, bypassing the non-PCI center.

Eur Heart J 2008; 29: 1793-1794