Specialist Transfer to Patients With MI Improves Outcome
Transfer of specialists to patients makes balloon angioplasty within 90 minutes of MI possible
WEDNESDAY, April 27 (HealthDay News) -- Transfer of qualified interventionalists to hospitals without interventionalists qualified for primary percutaneous coronary intervention (PPCI) may be more effective at improving care of patients with acute ST-segment elevation myocardial infarction (STEMI) than transferring patients to hospitals with qualified interventionalists, particularly where patient transfers could be delayed by congestion, according to a study published online April 26 in Circulation: Cardiovascular Quality and Outcomes.
Qi Zhang, M.D., from the Shanghai Jiaotong University School of Medicine in China, and colleagues investigated whether an interventionalist-transfer strategy for PPCI to hospitals without qualified interventionalists could shorten door-to-balloon (D2B) time and improve one-year clinical outcome compared to patient transfer to hospitals with qualified interventionalists. They randomized 165 patients with acute STEMI to receive PPCI by an interventionalist-transfer and 169 by patient-transfer strategy and compared D2B time, left ventricular ejection fraction, and major adverse cardiac events (MACE) at one year.
The investigators found that interventionalist-transfer strategy significantly shortened average D2B time compared to patient-transfer strategy (92 versus 141 minutes), with 21.2 percent of patients in the interventionalist-transfer group having balloon angioplasty within 90 minutes of acute STEMI compared to 7.7 percent in the patient-transfer group. Compared to patient transfer, interventionalist-transfer strategy was correlated with significantly higher left ventricular ejection fraction (0.60±0.07 versus 0.57±0.09) and improved one-year MACE-free survival (84.8 versus 74.6 percent). Interventionalist-transfer strategy independently reduced the risk of composite MACE (hazard ratio, 0.63).
"The interventionalist-transfer strategy resulted in significantly shorter door-to-balloon times and better one-year clinical outcomes," the authors write.