Hospital transfer for primary coronary angioplasty in high risk patients with acute myocardial infarction

Abstract

(Heart 1999;82:415-419)

The Case for Community Hospital Angioplasty

“…In the NRMI-2 registry, the odds-adjusted mortality of patients with STEMI who received primary PCI was 33% lower at institutions that performed more than 33 primary PCI procedures per year than at institutions that performed fewer than 12 per year. 55 These higher-volume hospitals also had faster times to reperfusion. On the basis of these data, the current ACC/AHA PCI and AMI guidelines recommend a minimum volume of 36 primary PCI procedures per year for nonsurgical hospitals that perform primary PCI.…”

“…The feasibility and safety of emergent transfer for primary PCI were initially described in small case series [52][53][54][55][56][57] and more recently in 5 randomized controlled trials. 18,58 -61 Combined Figure 1.…”

“…Individual studies have shown that transfer is safe even in high-risk patients (defined as Ͼ70 years of age, anterior myocardial infarction, Killip class II/III, heart rate Ͼ100 bpm or systolic blood pressure Ͻ100 mm Hg, cardiogenic shock, need for cardiopulmonary resuscitation before transfer, and contraindications for thrombolytic therapy). 18,52,55 In a subgroup analysis, 1 the risks associated with transfer for primary PCI were calculated for the 5 transfer trials. 18,58 -61 Overall, events during transfer occurred infrequently: 0.5% risk of death (reported in 1 study 60 ), 0.7 to 1.4% risk of ventricular arrhythmias, 58 -61 and a 2.3% risk of second-or third-degree heart block (reported in 1 study 61 ).…”

ACC/AHA/SCAI Practice Guidelines, February 21, 2006

“…The enthusiasm for primary PCI has led to the concept of emergency interhospital transfer for catheter-based reperfusion rather than fibrinolytic therapy in the initial hospital (425)(426)(427). Five randomized trials have enrolled 2466 patients with favorable results for PCI versus fibrinolytic therapy (378,381,407,412).…”

Inter-hospital Transport for Primary Angioplasty Does Not Compromise Left Ventricular Function

“…12) To date, few studies have been published comparing left ventricular function outcome in patients who underwent thrombolytic therapy in a primary hospital with that in patients transported for primary angioplasty. 13,14) Therefore, the question arises whether the general benefit from coronary angioplasty outweighs the disadvantage of the time delay. Similarly, until recently it was unclear whether patient transport for primary angioplasty was safe.…”