Abstract 1990: Re-appraisal Of Interhospital Transfer For Primary Angioplasty In The Context Of An Effective Service With Rapid Institutional Door-balloon Times
Objective: Primary Percutaneous Coronary Intervention (PPCI) is the preferred reperfusion therapy in ST elevation myocardial infarction. Guidelines recommend door-balloon time of < 90 minutes and an attributable delay beyond when thrombolysis (TL) could be given of < 1 hour. We appraised our single centre experience to determine compliance with guidelines and clinical outcomes in a ‘real world’ setting.
Method: We prospectively analysed consecutive case time-interval data and 30 day mortality for 24 months from April 2004–March 2006 for direct access PPCI and interhospital transfer (IHT) PPCI and made a comparison with TL era data from the previous two years. Kaplan-Meier analysis was used to ensure ‘long wait’ patients were represented.
Results: The median door-balloon/needle times were 24 minutes for direct access (n=180), 97 minutes for IHT (n=105) and 18 minutes with TL (n=181). First Professional Contact-balloon/needle times were 68 minutes for direct access, 131 minutes for IHT and 46 minutes with TL. With direct admission door-balloon time was < 1 hour in all cases. With IHT door-balloon time was <90 minutes in 44% of cases. The thirty day mortality was 10.8% with IHT, 8.5% with TL and 2.8% with direct access (p=0.02 vs TL).
Conclusion: In spite of ongoing debate, direct access PPCI with autonomous ambulance triage can readily achieve door-balloon times well within internationally accepted guidelines. However even in the context of rapid institutional times, ‘real world’ IHT introduces major delays which may compromise outcome, and reperfusion strategy should consider individual patient and local service characteristics, rather that the ‘wholesale’ uptake of PPCI.