Abstract 10899: Direct Cath Lab Access Reduced Reperfusion Delays and Mortality for Transferred-in STEMI Patients: Insights From Mission: Lifeline
Background: For STEMI patients requiring transfer for primary PCI, direct transfer to the STEMI receiving hospital cath lab may expedite reperfusion but can be logistically challenging. The difference in outcome for patients transferred directly to the cath lab compared to the ED or hospital ward is unknown.
Methods: We studied 35,127 STEMI patients transferred for primary PCI to a STEMI receiving hospital in ACTION Registry®-GWTG™ from July 2008 - Dec 2012). Using multivariable logistic regression, we compared in-hospital mortality risks between patients transferred directly to the cath lab and those transferred to the ED/ward.
Results: A total of 7,560 STEMI patients (22%) were transferred to an ED/ward of the STEMI receiving hospital rather than directly to the cath lab. STEMI patients transferred to an ED/ward were older, more likely to have prior MI and higher predicted mortality risk compared with patients transferred directly to the cath lab (Table). They were modestly less likely to present with clear ST-elevation on admission ECG and more likely to have heart failure or shock on presentation. Patients transferred to an ED/ward had a median delay of 30 minutes (IQR 15, 61) to cath lab arrival, and door to balloon time was significantly higher for these patients compared with those transferred directly to the cath lab (115 vs. 188 minutes). Transfer directly to the cath lab vs. ED/ward was associated with significantly lower mortality (4.6% vs. 11.1%, adjusted OR 0.58, 95% CI 0.51-0.65). This association with lower mortality persisted after excluding patients with admission heart failure, shock, no primary PCI, or non-system reasons for delay to primary PCI (adjusted OR 0.62, 95% CI 0.46-0.83).
Conclusion: Direct transfer of STEMI patients to the cath lab for primary PCI reduced reperfusion delays by more than an hour and was associated with lower mortality risk compared with transfer to the ED or other hospital ward.
- © 2013 by American Heart Association, Inc.