Abstract 2071: Inter-Hospital Transfer of High Risk ST Segment Elevation Myocardial Infarction Patients for Percutaneous Coronary Intervention is Safe and Feasible
Objective: Primary percutaneous coronary intervention (PCI) is superior for STEMI if performed at experienced centers in a timely fashion, however only 25% of hospitals have PCI capability. For those patients presenting to a non-PCI hospital, ACC/AHA STEMI Guidelines recommend immediate transfer for PCI, especially in high risk patients, although the risks of inter-hospital transfer have not been well documented.
Methods: A standardized protocol (“Level 1 MI Program”) for transfer of STEMI patients to Abbott Northwestern Hospital, a tertiary cardiac center in Minneapolis, from 28 rural and community hospitals was implemented. No patients were excluded from transfer including cardiogenic shock and post cardiac arrest. We report the results of adverse events during inter-hospital transfer of STEMI patients for PCI.
Results: From 7/03 to 4/06, 774 consecutive STEMI patients were transferred from the emergency department for direct PCI from 28 hospitals ranging from 23 to 210 miles away. Sixty-nine percent were transferred by air and 31% by ground ambulance with median transport times of 23 and 32 minutes respectively. High risk characteristics prior to transfer include cardiogenic shock 90 (11.6%); pretransfer cardiac arrest 52 (6.7%); and endotracheal intubation 36 (4.6%) pretransfer and in 5 (0.6%) during transfer. There were no deaths during transfer. Cardiopulmonary arrest occurred during transfer in 12 [Ventricular fibrillation - 9 (1.2%); asystole - 2 (0.2%); respiratory arrest - 1 (0.1%)]. All were resuscitated with return of spontaneous circulation. In-hospital deaths occurred in 3 of these patients (2 with severe cardiogenic shock died during angiography and 1 within 24 hours due to anoxic brain injury). The remaining 9 were discharged neurologically intact.
Conclusion: Transfer of STEMI patients including unstable patients with cardiogenic shock and post cardiac arrest from community hospitals for PCI utilizing an established transfer protocol is safe and effective. These data represents the largest reported series of STEMI patients transferred for PCI.