This article is more than 5 years old. Information may no longer be current.
Direct admission to primary PCI center preferable to inter-hospital transfer in STEMI
In patients with STEMI treated with primary PCI, direct admission to a PCI center was associated with significantly lower 12-month mortality rate vs. transfer to a PCI center through a regional non-PCI–capable facility.
Using data from 2006 to 2013 from the ongoing, prospective, observational, nationwide PL-ACS registry in Poland, researchers found that median symptoms-to-admission time was 44 minutes shorter with direct admission to a PCI center vs. inter-hospital transfer (P < .001). Direct admission was also associated with shorter total ischemic time (228 vs. 270 minutes; P < .001) and higher left ventricular ejection fraction (47.5% vs. 46.3%; P < .001). Additionally, more patients who were admitted directly underwent PCI within 2 hours from symptom onset (13.6% vs. 9%).
Mortality reduced
Results also linked direct admission to lower propensity-matched 12-month mortality (9.6% vs. 10.4%; P < .001), with direct admission (HR = 1.06; 95% CI, 1.01-1.11) and shorter symptoms-to-admission time (HR = 1.03; 95% CI, 1.01-1.06) being significant predictors of lower 12-month mortality in propensity-matched multivariate Cox analysis.
“Direct admission to a primary PCI center seems to be better than involvement of a regional hospital and subsequent transfer for primary PCI should be considered the preferred strategy in all STEMI cases,” the researchers wrote.
The PL-ACS registry included all admitted patients with confirmed STEMI. A total of 70,093 patients were included in the analysis, 39,144 (56%) of whom were admitted directly to a PCI center.
Process improvements
In an accompanying editorial, Peter B. Berger, MD, senior vice president of clinical research for North Shore-LIJ Health System, Great Neck, New York, Molly Perini, director of quality systems and improvement for the American Heart Association’s Mission: Lifeline, and Lance B. Becker, MD, chair and professor of emergency medicine at the Hofstra Northwell School of Medicine, Hempstead, New York, identified areas for further research. For instance, they questioned whether EMS bypassed closer hospitals without the capability to provide emergency PCI to go directly to primary PCI centers.
“It seems nearly certain that bypass of non-PCI hospitals did occur frequently, as the percentage of patients taken directly to a PCI hospital increased significantly during the 8-year study period,” they wrote. “An analysis that might have provided additional valuable information that was not reported would compare patients taken to the nearest non-PCI hospital with patients who bypassed the nearest hospital not offering PCI and were instead transported to the further PCI hospital.”
Berger, Perini and Becker also said the study emphasizes the need for process improvements.
“[The researchers] deserve credit for shining a light on suboptimal STEMI practices in their native Poland. Clinician-investigators in the [U.S.] have been doing the same, and it is clear that many areas of the [U.S.] are in need of process improvement if we want to optimize our STEMI-related health outcomes. We know what has to be done. Now is the time to act,” they wrote. – by Melissa Foster
Disclosure: The researchers, Becker, Berger and Perini report no relevant financial disclosures.