Abstract 2072: Time-to-Reperfusion in Patients Undergoing Interhospital Transfer for Primary Percutaneous Coronary Intervention in the United States: Results from the National Cardiovascular Data Registry
Background: Early studies suggested that patients undergoing transfer for primary PCI in the US have substantial delays to reperfusion. However, contemporary data have not been reported.
Methods: We examined data from more than 400 hospitals in the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) on time-to-reperfusion among patients transferred for primary PCI in 2005. We limited our study population to patients who were transferred from another acute-care hospital and excluded those receiving fibrinolytic therapy even when a facilitated PCI strategy was employed. We calculated total door-to-balloon (DTB) time from arrival at the initial hospital to first balloon inflation at the PCI hospital. Patient characteristics across different categories of total DTB time (< 2 hours, 2–3 hours, 3–4 hours, and >4 hours) were compared using Student t-tests and chi-squared tests.
Results: We identified 9085 patients who were transferred for primary PCI in 2005. The median total DTB time was 177 minutes (interquartile range, 127–273). The mean age was 60.4 (± 13.3) years; 29.0% were women, 88.3% were white, 32.9% presented during weekday working hours. When compared with patients with total DTB times < 2 hours, patients with total DTB times > 4 hours were older (60.9 vs. 59.0; P< 0.001) and more likely to be female (31.4% vs. 23.8%; P< 0.001), non-white (13.9% vs. 10.9%; P= 0.001), and to present in heart failure (12.7 vs. 7.7; P< 0.001) or with cardiogenic shock (11.5 vs. 9.0; P< 0.001). Patients with longer total DTB times also had significantly higher rates of in-hospital death (3.1% for patients with total DTB times < 2 hours, 3.7% for 2–3 hours, 6.8% for 3–4 hours, 6.0% for > 4 hours).
Conclusions: Total DTB times in patients undergoing transfer for primary PCI continue to be markedly delayed in the US and may be contributing to excess mortality. These findings support the need for improved transfer protocols to reduce time-to-reperfusion and improve patient outcomes in this high-risk group.