• EuroIntervention · Aug 2010

    Comparative Study

    Direct transfer of ST-elevation myocardial infarction patients for primary percutaneous coronary intervention from short and long transfer distances decreases temporal delays and improves short-term prognosis: the PROGALIAM Registry.

    • Rodrigo Estévez-Loureiro, Ramon Calviño-Santos, Jose-Manuel Vázquez-Rodríguez, Raquel Marzoa-Rivas, Eduardo Barge-Caballero, Jorge Salgado-Fernández, Guillermo Aldama-López, Maria Barreiro-Díaz, Jacobo Varela-Portas, Miguel Freire-Tellado, Nicolas Vázquez-González, and Alfonso Castro-Beiras.
    • Cardiology Department, Complejo Hospitalario, Universitario A Coruña, La Coruña, Spain. Rodrigo.Estevez.Loureiro@sergars.es
    • EuroIntervention. 2010 Aug 1; 6 (3): 343-9.

    AimsThis study sought to evaluate the impact of a direct transfer strategy on treatment times and prognosis of patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous intervention (PPCI).Methods And ResultsWe conducted a cohort study of 1,194 patients who underwent PPCI in our centre between May 2005 and December 2008. We studied the role of direct transfer on time to treatment and door-to-balloon delays and its effect on 30-day mortality adjusted by risk profile on admission. During this period, 255 patients (21%) experienced direct transfer (DT) from the field to the catheterisation laboratory. Patients referred directly for PPCI experienced lower median door-to-balloon delay (102 minutes vs. 125 minutes, p<0.0001) and lower time to treatment (median 189 minutes vs. 259 minutes, p<0.0001) when compared with those referred from emergency departments (ED). These differences were consistent, with respect to door-to-balloon delay and time to treatment interval, in patients from our catchment area: median 88 vs. 98 minutes, (p=0.003) and 174 vs. 219 minutes (p<0.0001) respectively, and from long-distance transfer: 110 vs. 169 minutes (p<0.0001) and 197 minutes vs. 342 minutes (p<0.0001) respectively. Patients in the DT group experienced lower 30-day mortality than patients transferred from the ED (2.7% vs. 6.8%, p=0.017). In a multivariable analysis, DT strategy was independently associated with better short-term prognosis (OR 0.33, CI95% 0.12 - 0.92).ConclusionsDirect transfer reduces time delays and improves prognosis of patients with STEMI undergoing PPCI.

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