Direct admission versus transfer of AMI patients for primary PCI.

BACKGROUND: Guidelines for the treatment of patients with ST-elevation myocardial infarction (STEMI) recommend primary PCI as first choice therapy. This recommendation has been linked to defined time limits achievable in a logistic network for the treatment of ACS. In the present study we analyzed the difference in 6 months outcome between STEMI patients who were admitted directly to a PCI center and those requiring transfer for primary PCI.
RESULTS: 2,034 consecutive patients were included in the Bad Nauheim ACS registry. Admission diagnosis was STEMI in 1,057 (52%) patients (71% male, aged 63 ± 13). 637 (60%) patients were directly admitted for primary PCI with a time delay from first medical contact until admission in the PCI center of 64 min (IQR 45-90) at median and door-to-balloon time (DTB) at median 29 min (IQR 20-41). 420 (40%) patients were transferred from peripheral hospitals. In this subgroup time delay was 135 min (IQR 69-285) and DTB at median 31 min (IQR 22-49). 178 (16.8%) patients were at high risk (CPR or cardiogenic shock). Patients, who were admitted directly had a better outcome as transferral patients (log rank 6.1; p = 0.013 for 6 months mortality). However, Kaplan-Meier survival analysis (log rank 4.25; p = 0.039) and Cox regression analysis (95% CI 1.08-3.17; p = 0.026) revealed that this difference in outcome was restricted to high-risk patients.
CONCLUSION: A network for the treatment of STEMI provides the logistic basis for the initiation of primary PCI according to current guidelines. However, transferral patients do not meet the defined time limits. Mortality rates for high-risk transferral patients appear to be higher as those of patients taken directly to the center by the EMS.