Study Shows Benefit of Direct Transfer to Catheterization Lab for STEMI Patients

September 18, 2015—Direct transfer of ST-segment elevation myocardial infarction (STEMI) patients to the cardiac catheterization lab (CCL) for primary percutaneous coronary intervention (PCI) was associated with significantly faster reperfusion and lower mortality risk compared with transfer first to the emergency department/ward, concluded a study published by Lindsay L. Anderson, MD, et al online ahead of print in Circulation: Cardiovascular Interventions.

As summarized in Circulation: Cardiovascular Interventions, the investigators studied 33,901 STEMI patients transferred for primary PCI in the Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With The Guidelines from July 2008 to December 2012. The majority of patients were transferred directly to the CCL (26,510 [78.2%]); the remaining patients (7,391 [21.8%]) were first transferred to the hospital emergency department/ward.

The investigators observed significant interhospital variation in transfer patterns; only 21% of STEMI-receiving hospitals routinely transferred more than 90% of STEMI patients to the CCL directly. Compared with patients transferred first to the emergency department/ward, STEMI patients transferred to the CCL had significantly lower first door-to-balloon times (median 191 minutes vs 116 minutes; P < .0001).

After multivariable logistic regression, patients transferred directly to the CCL also had lower adjusted mortality risk (odds ratio [OR] 0.58; 95% confidence interval [CI], 0.51–0.66; P < .0001). Cardiogenic shock, heart failure signs/symptoms, and nonsystem reasons for reperfusion delay were present in 11%, 15%, and 28% of patients transferred first to the emergency department/ward, respectively. The investigators reported that the association of direct CCL transfer with lower mortality persisted after excluding patients with these reasons for delay to primary PCI (adjusted OR 0.62; 95% CI 0.46–0.84; P = .002).