Abstract 6177: Impact of Transfer Time on Mortality of the Urban STEMI Treated with Primary Angioplasty
In STEMI, conflicting data exists on the relative importance of patient-dependent time (Symptom-Onset (SO) to first medical contact (FMC)) and Transfer Time (TT=time from FMC to sheath insertion). We assessed the impact of TT on in-hospital (IH) mortality in a well organized urban network using Mobile Intensive Care Units (MICU). In a web-based registry (e-PARIS), 705 consecutive STEMI patients transferred to the Pitié-Salpêtriére cath-lab for primary PCI were evaluated. Population was 63±14 y/o, 75.6% were male, 46.9% had anterior MI, 16.7% were in Killip class ≥ 2, and 3.8% had out-of-hospital cardiac arrest. Abciximab use was 82.4%, radial approach 87.7% and stenting in 89.7% of patients. Median time (± IQR) from SO to FMC was 110±248 min (102±190 min when FMC was MICU and 160±381 min when FMC was a referring hospital, p<0.0001). Median TT was 104±75 min (95±45 min for MICU and 151±178 min for patients transferred from a primary hospital, p<0.0001). When divided into quartiles, increasing TT was associated with higher IH mortality (fig⇓). This relation to IH mortality was striking in patients presenting early (within 2 hours of SO), and not significant in late presenters (>2 hours of SO). However, after multivariate analysis and adjustment for the baseline characteristics, TT was not associated to mortality anymore. In conclusion, the association between TT and early mortality is strongly dependent on baseline patients’ characteristics and time to presentation. After adjustment for these parameters, TT does not appear to be a major contributor of IH mortality in a well organized urban network for primary PCI. Improvements in time-to- first medical contact may be more critical.