Damian Kawecki1, Marek Gierlotka2, Beata Morawiec3, Michał Hawranek2, Mateusz Tajstra2, Michał Skrzypek4, Wojciech Wojakowski5, Lech Poloński2, Ewa Nowalany-Kozielska3, Mariusz Gąsior2. 1. 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland. Electronic address: d.kawecki@interia.pl. 2. 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland; Department of Science, Training and New Medical Technologies, Silesian Center for Heart Diseases, Zabrze, Poland. 3. 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland. 4. Department of Science, Training and New Medical Technologies, Silesian Center for Heart Diseases, Zabrze, Poland; Department of Biostatistics, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland. 5. 3rd Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
Abstract
OBJECTIVES: This study sought to assess the influence of direct admission versus transfer via regional hospital to a percutaneous coronary intervention (PCI) center on time delays and 12-month mortality in ST-segment elevation myocardial infarction (STEMI) patients from a real-life perspective. BACKGROUND: Reduction of delays to reperfusion is crucial in a STEMI system of care. However, it is still debated whether direct admission to a PCI center is superior to interhospital transfer in terms of long-term prognosis. The authors hypothesized that compared with interhospital transfer, direct admission shortens the total ischemic time, limits the loss of left ventricular systolic function, and finally, reduces 12-month mortality. METHODS: Prospective nationwide registry data of STEMI patients admitted to PCI centers within 12 h of symptom onset and treated with PCI between 2006 and 2013 were analyzed. Patients admitted directly were compared with patients transferred to a PCI center via a regional non-PCI-capable facility in terms of time delays, left ventricular ejection fraction (LVEF), and 12-month mortality. Data were adjusted using propensity-matched and multivariate Cox analyses. RESULTS: Of the 70,093 patients eligible for analysis, 39,144 (56%) were admitted directly to a PCI center. Direct admission was associated with a shorter median symptoms-to-admission time (by 44 min; p < 0.001) and total ischemic time (228 vs. 270 min; p < 0.001), higher LVEF (47.5% vs. 46.3%; p < 0.001), and lower propensity-matched 12-month mortality (9.6% vs. 10.4%; p < 0.001). In propensity-matched multivariate Cox analysis, direct admission (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01 to 1.11) and shorter symptoms-to-admission time (HR: 1.03; 95% CI: 1.01 to 1.06) were significant predictors of lower 12-month mortality. CONCLUSIONS: In a large, community-based cohort of patients with STEMI treated by PCI, direct admission to a primary PCI center was associated with lower 12-month mortality and should be preferred to transfer via a regional non-PCI-capable facility.
OBJECTIVES: This study sought to assess the influence of direct admission versus transfer via regional hospital to a percutaneous coronary intervention (PCI) center on time delays and 12-month mortality in ST-segment elevation myocardial infarction (STEMI) patients from a real-life perspective. BACKGROUND: Reduction of delays to reperfusion is crucial in a STEMI system of care. However, it is still debated whether direct admission to a PCI center is superior to interhospital transfer in terms of long-term prognosis. The authors hypothesized that compared with interhospital transfer, direct admission shortens the total ischemic time, limits the loss of left ventricular systolic function, and finally, reduces 12-month mortality. METHODS: Prospective nationwide registry data of STEMI patients admitted to PCI centers within 12 h of symptom onset and treated with PCI between 2006 and 2013 were analyzed. Patients admitted directly were compared with patients transferred to a PCI center via a regional non-PCI-capable facility in terms of time delays, left ventricular ejection fraction (LVEF), and 12-month mortality. Data were adjusted using propensity-matched and multivariate Cox analyses. RESULTS: Of the 70,093 patients eligible for analysis, 39,144 (56%) were admitted directly to a PCI center. Direct admission was associated with a shorter median symptoms-to-admission time (by 44 min; p < 0.001) and total ischemic time (228 vs. 270 min; p < 0.001), higher LVEF (47.5% vs. 46.3%; p < 0.001), and lower propensity-matched 12-month mortality (9.6% vs. 10.4%; p < 0.001). In propensity-matched multivariate Cox analysis, direct admission (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01 to 1.11) and shorter symptoms-to-admission time (HR: 1.03; 95% CI: 1.01 to 1.06) were significant predictors of lower 12-month mortality. CONCLUSIONS: In a large, community-based cohort of patients with STEMI treated by PCI, direct admission to a primary PCI center was associated with lower 12-month mortality and should be preferred to transfer via a regional non-PCI-capable facility.
Authors: Jared P Beller; Robert B Hawkins; J Hunter Mehaffey; William Z Chancellor; Clifford E Fonner; Alan M Speir; Mohammed A Quader; Jeffrey B Rich; Leora T Yarboro; Nicholas R Teman; Gorav Ailawadi Journal: J Thorac Cardiovasc Surg Date: 2019-02-11 Impact factor: 5.209
Authors: Abhijat Kitchlu; Joshua Shapiro; Justin Slater; K Scott Brimble; Jade S Dirk; Nivethika Jeyakumar; Stephanie N Dixon; Amit X Garg; Ziv Harel; Andrea Harvey; S Joseph Kim; Samuel A Silver; Ron Wald Journal: Kidney360 Date: 2020-09-17