Abstract 13146: The Benefit of Transferring STEMI Patients for PCI Compared with Administration of Onsite Fibrinolytic Declines as Delays Increase
Background: Randomized trials suggest that transfer for primary percutaneous coronary intervention (X-PCI) in STEMI is superior to onsite fibrinolytic therapy (O-FT), but the time dependent effect of this benefit in a less selected population has not been described. Transport and door-to-balloon times (DB) are rapid in randomized trials, but they are often prolonged in routine practice. We hypothesized that delays due to transfer would reduce the survival advantage compared with O-FT.
Methods: Patients with STEMI on initial ECG and <12 hours after onset of pain enrolled in the National Registry of Myocardial Infarction receiving either O-FT or X-PPCI were identified. Propensity score matching was performed and the effect of PCI related delay on in-hospital mortality was assessed. PCI-related delay (DB-DN) was calculated by subtracting the door-to-needle time from the DB in the matched pair. Conditional logistic regression adjusting for patient and hospital variables was utilized identifying the DB-DN where no mortality advantage for X-PCI over O-FT was present.
Results: The baseline characteristics of the matched groups were similar. 81% of X-PCI patients were matched (n=9,506) to O-FT patients (n=9,506). In the matched cohort, X-PCI was performed with delays exceeding 90 minutes in 68%. Multivariable analysis found no mortality advantage for X-PCI over O-FT when DB-DN exceeded 107 minutes.
Conclusions: PCI related delays are extensive amongst patients transferred for PPCI and are associated with adverse outcomes. No differential excess in mortality was seen with X-PCI compared with O-FT even with long PCI-related delays, but as DB-DN times increase, the mortality advantage for X-PCI over O-FT declines. Further study is needed in order to better identify specific patient populations in which the impact of transfer-related delay to X-PCI can be mitigated.
- © 2010 by American Heart Association, Inc.