Transfer delays associated with varying clinical outcomes

Miedema M. Circulation. 2011;doi:10.1161/CIRCULATIONAHA.111.033118.

Clinical outcomes vary depending on the delay in interhospital transfer for percutaneous coronary intervention, and not all delays are STEMI system dependent, researchers in a recent study wrote.

Using a standardized protocol designed to improve time to treatment and clinical outcomes in patients with STEMI presenting to community hospitals without PCI capability, those included had STEMI or new left bundle-branch block and chest pain of less than 24 hours who were transferred for primary PCI from March 2003 to December 2009.

Researchers categorized referral hospital door-in to door-out delays of more than 45 minutes into six categories: nondiagnostic electrocardiograms, diagnostic dilemma, ED delay, cardiogenic shock and/or cardiac arrest, awaiting transport, and other; PCI center door-to-balloon delays of more than 30 minutes were categorized as cath lab team delay, complex procedure, cardiogenic shock/cardiac arrest in the cath lab, diagnostic dilemma, and other.

A total of 2,034 patients were transferred for PCI, and 12.6% of patients experienced a delay. The most common reasons for delay were waiting for transport and ED delay at the referral hospital and cath lab team delay and complex procedure at the PCI hospital. The longest delays were among patients with nondiagnostic initial ECG in the referral hospital and diagnostic dilemmas at the referral and PCI hospitals. Both hospitals also experienced higher mortality rates in patients with cardiogenic shock or cardiac arrest.

Overall, 30.4% of patients were treated in 90 minutes or less and 65.7% were treated in 120 minutes or less, according to researchers. In-hospital mortality increased in patients whose total door-to-balloon time was more than 120 minutes (95% CI, 3-5.1). Only 15.7% of patients had door-to-balloon delays of more than 30 minutes.

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