Direct admission to PCI center improves long-term survival in STEMI

Among patients with STEMI, those admitted directly to a PCI center had better outcomes than those who had to be transferred to a PCI center from another hospital, researchers reported at the Acute Cardiovascular Care Congress.

“Our findings indicate that the superior survival in patients admitted directly to a primary PCI hospital was because there was a shorter gap between calling for help and receiving treatment,” Krishnaraj Rathod, MBBS, PhD, cardiology specialist registrar at The Barts Health NHS Trust, London, said in a press release.

The researchers conducted an observational study of 25,315 patients with STEMI (mean age, 62 years; 77% men) between 2005 and 2015 at eight tertiary cardiac centers in the London area. Patients were stratified by whether they were directly admitted to a PCI center or were transferred from a hospital without primary PCI capabilities.

“In our study, nearly one-third were taken to another hospital first, indicating that a STEMI diagnosis was not made until patients reached that hospital, and they then had to be transferred,” Rathod said in the release. “However, it must be noted that the rates of transfer directly to a primary PCI center were better in the later years, suggesting better identification of appropriate patients by health care staff.”

The primary outcome was all-cause mortality. Median follow-up was 4.8 years.

Compared with the direct admission group, the transferred group had a longer symptom-to-balloon time (216 minutes vs. 164 minutes; P < .0001) and a longer call-to-balloon time (160 minutes vs. 108 minutes; P < .0001), Rathod and colleagues found.

The direct admission group had a lower mortality rate during follow-up than the transferred group (17.4% vs. 18.7%; P = .047), and after adjustment for propensity scores and other factors, transfer of patients predicted all-cause mortality regardless of whether symptom-to-balloon time was included in the model (HR = 0.8; 95% CI, 0.61-0.96) or not (HR = 0.84; 95% CI, 0.65-0.98), according to the researchers.

A propensity-matched analysis had similar results (HR = 0.86; 95% CI, 0.68-0.91).

“Directly admitted patients were sicker but they were also older, indicating that paramedics may think heart attack is unlikely in younger adults,” Rathod said in the release. “My message to them is, ‘In cases of doubt, repeat the 12-lead ECG and consider speaking to the heart attack center.’” – by Erik Swain

Reference:

Rathod K, et al. Abstract 449. Presented at: Acute Cardiovascular Care Congress; March 2-4, 2019; Malaga, Spain.

Disclosure: Rathod reports no relevant financial disclosures.