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Direct transfer of ST-elevation myocardial infarction patients for primary percutaneous coronary intervention from short and long transfer distances decreases temporal delays and improves short-term prognosis: the PROGALIAM Registry

2010; European Association of Percutaneous Cardiovascular Interventions; Volume: 6; Issue: 3 Linguagem: Inglês

10.4244/eijv6i3a57

1969-6213

Rodrigo Estévez‐Loureiro, Ramón Calviño‐Santos, José Manuel Vázquez‐Rodríguez, Raquel Marzoa‐Rivas, Eduardo Barge‐Caballero, Jorge Salgado‐Fernández, Guillermo Aldama-López, Maria Barreiro-Díaz, Jacobo Varela-Portas, Miguel Freire-Tellado, Nicolás Vázquez‐González, Alfonso Castro‐Beiras,

Trauma and Emergency Care Studies

This study sought to evaluate the impact of a direct transfer strategy on treatment times and prognosis of patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous intervention (PPCI).We conducted a cohort study of 1,194 patients who underwent PPCI in our centre between May 2005 and December 2008. We studied the role of direct transfer on time to treatment and door-to-balloon delays and its effect on 30-day mortality adjusted by risk profile on admission. During this period, 255 patients (21%) experienced direct transfer (DT) from the field to the catheterisation laboratory. Patients referred directly for PPCI experienced lower median door-to-balloon delay (102 minutes vs. 125 minutes, p<0.0001) and lower time to treatment (median 189 minutes vs. 259 minutes, p<0.0001) when compared with those referred from emergency departments (ED). These differences were consistent, with respect to door-to-balloon delay and time to treatment interval, in patients from our catchment area: median 88 vs. 98 minutes, (p=0.003) and 174 vs. 219 minutes (p<0.0001) respectively, and from long-distance transfer: 110 vs. 169 minutes (p<0.0001) and 197 minutes vs. 342 minutes (p<0.0001) respectively. Patients in the DT group experienced lower 30-day mortality than patients transferred from the ED (2.7% vs. 6.8%, p=0.017). In a multivariable analysis, DT strategy was independently associated with better short-term prognosis (OR 0.33, CI95% 0.12 - 0.92).Direct transfer reduces time delays and improves prognosis of patients with STEMI undergoing PPCI.