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Interventionalist-transfer strategy improved door-to-balloon time
Zhang Q. Circ Cardiovasc Qual Outcomes. 2011;4:355-362.
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For patients with acute STEMI, an interventionalist-transfer strategy shortened door-to-balloon time compared with patient-transfer strategy by a median of almost 50 minutes, according to new results.
All patients in the study (n=334) had acute STEMI and presented to five referral hospitals in Shanghai, China, within 12 hours of symptom onset. They were randomly assigned to receive treatment with primary percutaneous coronary intervention and either an interventionalist-transfer strategy (n=165) or a patient-transfer strategy (n=169). The primary endpoint was door-to-balloon time and secondary endpoints were left ventricular ejection fraction and major adverse cardiac events at 1 year.
Analysis revealed a significantly shorter primary endpoint with the interventionalist- vs. patient-transfer strategies (median, 92 minutes vs. 141 minutes; P<.0001). The delay associated with the patient-transfer strategy, according to data, was primarily due to the extra time waiting for ambulance arrival at the local hospital (median, 21 minutes) and the time transferring the patient from the ED to the catheterization laboratory in the tertiary hospital (median, 15 minutes).
Similarly, for the interventionalist strategy, LVEF was also improved (0.60 ± 0.07 vs. 0.57 ± 0.09; P<.001), as was 1-year major adverse coronary event-free survival (84.8% vs. 74.6%, P=.019; HR=0.63).
“Primary PCI with an interventionalist-transfer strategy may be a useful approach to improve the care of patients with STEMI presenting to a non-[primary]PCI-capable hospital, particularly in a congested metropolitan region where patient transfers could be prolonged,” the researchers concluded.
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