Abstract 4498: A Pharmaco-invasive Reperfusion Strategy With Immediate Percutaneous Coronary Intervention is Safe and Effective in ST-Elevation Myocardial Infarction Patients With Expected Delays Due to Long Distance Transfer
Background: Controversy exists regarding the optimal reperfusion strategy for STEMI patients who present to rural hospitals located long distances from a percutaneous coronary intervention (PCI) center. Recent data (CARESS and TRANSFER-AMI) support a pharmaco-invasive (PI) approach over fibrinolytic therapy with rescue PCI; however, the timing of PCI (immediate vs. delayed) remains controversial.
Methods: The Minneapolis Heart Institute at Abbott Northwestern Hospital (ANW) performs PCI on all STEMI patients that are transferred from 32 community hospitals without PCI capability. Patients at the PCI hospital or transferred from hospitals ≤60 miles (Zone 1) away undergo primary PCI. Per standardized protocol, STEMI patients presenting to hospitals >60 miles (Zone 2) away receive aspirin 325mg, unfractionated heparin, clopidogrel 600mg, ½ dose fibrinolytic (unless contraindicated) and are transferred for immediate PCI. We report the clinical outcomes in STEMI patients receiving PI therapy with transfer for immediate PCI.
Results: From 3/03 to 12/08, 2,264 STEMI patients were enrolled including 605 who received PI therapy and long distance transfer for immediate PCI (Zone 2–96%, Zone 1– 4%). Median door to needle and door to balloon times were 29 and 121 minutes respectively in the PI group. Despite longer time to treatment, there was no significant difference in mortality, stroke or bleeding in patients receiving PI therapy compared to primary PCI patients (Table⇓). In particular, despite a nearly 1 hour delay in total door to balloon time, mortality was identical to patients at the PCI center itself. Re-ischemia was less frequent than at the PCI hospital.
Conclusions: A PI approach with transfer for immediate PCI is a safe and effective reperfusion strategy for STEMI patients who present to rural hospitals located long distances from a PCI center.