Abstract 13504: Mortality in STEMI Patients Undergoing Inter-Hospital Transfer for Primary PCI in Massachusetts
Background: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for ST-elevation myocardial infarction (STEMI) if delivered in a timely fashion. To study the impact of efforts to reduce time to treatment in Massachusetts, we evaluated 7748 STEMI patients undergoing primary PCI between 1/2005 and 9/2008.
Methods: We used prospectively collected data compiled, audited, and analyzed by the Massachusetts Data Analysis Center, the state mandated PCI registry.
Results: The mean age of the population was 61.7 years, with 29% women and 5.6% in cardiogenic shock. In patients admitted directly to a PCI hospital (n=4987), mean door-to-balloon (DTB) time decreased from 2005 to 2008, with an increase in patients achieving a DTB time ≤90 minutes (Table). For patients requiring inter-hospital transfer (n=2761), mean DTB time improved but only a minority of patients achieved a total DTB time ≤90 minutes. Most of the delay was due to the time required for inter-hospital transfer (door of first hospital to door of PCI hospital 103.8 minutes in 2008). Longer DTB time was associated with increases in in-hospital and 30-day mortality (Figure).
Conclusion: Although DTB time has improved for STEMI patients in Massachusetts, only 15% of patients in this state-mandated registry who need inter-hospital transfer achieve the recommended target of ≤ 90 minutes (even lower than reported in large-scale voluntary registries). Moreover, for every 15 minute delay, in-hospital mortality increased by 4.7% [Odds Ratio 1.047 (1.003, 1.091)], P=0.03. Development of systems of care and strategies to decrease inter-hospital transfer time for STEMI patients are urgently needed.
- © 2010 by American Heart Association, Inc.