Abstract 11872: Mortality Benefit Associated with Direct Transfer from the Field of Primary Angioplasty in ST-Elevation Myocardial Infarction
BACKGROUND In comparison to interhospital transfer, reperfusion can be achieved faster when trained paramedics triage and transport STEMI patients (pts) directly to a designated PCI center. We sought to determine if the strategy of direct referral from the field impacted on mortality.
METHODS We have developed a regional system in which all STEMI pts are referred to a specialized center for primary PCI. We compared pts referred directly from the field by paramedics trained in the interpretation of the ECG (Field Group), and pts referred by emergency department (ED) physicians (ED Group). Our primary outcome was mortality at 180 days. Follow-up was obtained by chart review, clinic visit, or by telephone. The impact of baseline variables on mortality was assessed with univariable and multivariable analysis using logistic regression. For the multivariable analysis, the independent effect of the transfer group on mortality was assessed by controlling for baseline variables associated with mortality with p<0.15 in the univariable analysis.
RESULTS Between May 2005 and July 2010, 2032 consecutive STEMI pts were referred for primary PCI: 718 from the field and 1314 from the EDs. Primary PCI was performed in 93% of pts referred from the field and in 92% referred from the EDs, p=0.90. The median door-to-balloon time was shorter in pts referred from the field, 67 min (IQR 42-85) compared to pts needing interhospital transfer, 121 min (IQR 97-151), p<0.001; symptom onset-to-balloon was also shorter 160 min (IQR 121-223) vs. 242 min (IQR 175-381), p<0.001 respectively. Mortality at 180 days was 5.5% in pts referred from the field vs. 8.9% in pts referred by the EDs, (p=0.007). The results of the multivariable analysis are shown in the table.
CONCLUSION Within a STEMI system designed to reduce time to reperfusion for all pts, mortality was lower when trained paramedics triaged and transported pts directly to a designated primary PCI center as compared to when ED physicians transferred pts.
- © 2011 by American Heart Association, Inc.