Abstract P214: Fibrinolysis vs. Primary Percutaneous Intervention in ST-Elevation Myocardial Infarction with Long Distance Inter-Hospital Transfers
Background Current guidelines recommend rapid initiation of reperfusion therapy for STEMI, with short distance transfer for primary angioplasty preferred over fibrinolysis in non-PCI capable hospitals. Comparative outcomes in patients with longer transfer times are not known.
Objectives To assess whether administering fibrinolytics prior to initiating longer distance, inter-hospital transfers in patients with STEMI leads to a delay in transfer or worse outcomes when compared with direct transfer for primary PCI.
Methods We analyzed 259 STEMI patients transferred to a regional PCI center in Eastern North Carolina, 43 (16.6%) for primary PCI and the remaining 216 (83.4%) following fibrinolysis. The median distance to the PCI center from the peripheral hospitals was 52 miles (IQR 38 to 69). The primary end-point was door-to-door time. We also compared stroke, death, bleeding and combined outcomes between the two groups.
Results The median door-to-door time was similar for primary PCI and fibrinolysis patients (135 vs. 128 minutes; p=0.71). Median door-to-balloon time among primary PCI patients from the point of arrival at the peripheral hospital was 182 minutes and from arrival at the regional PCI center was 49 minutes. Median door-to-needle time in the fibrinolysis patients was 30 minutes, with rescue PCI eventually performed in 81 (37.5%) patients. In-hospital mortality was higher in patients with primary PCI (9.3%) compared to fibrinolysis patients (1.9%; p=0.03). Combined incidence of stroke, significant bleeding and death was 14% in primary PCI patients compared with 7% in fibrinolysis patients (p=0.13).
Conclusion In settings with longer transfer distances, administering fibrinolytics prior to transfer to a PCI center did not cause any significant delay in transfer or worse outcomes.