Inter-Facility Transfer vs. Direct Admission of Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Nakatsuma, Kenji; Shiomi, Hiroki; Morimoto, Takeshi; Furukawa, Yutaka; Nakagawa, Yoshihisa; Ando, Kenji; Kadota, Kazushige; Yamamoto, Takashi; Suwa, Satoru; Horie, Minoru; Kimura, Takeshi

doi:10.1253/circj.cj-16-0204

Cited by 25 publications

(25 citation statements)

References 25 publications

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“…Although the mortality rate reported by McNamara et al included all STEMI patients regardless of mode of presentation, the present analysis is limited to inter-facility transfers who are known to have longer ischemic time and higher mortality rate compared to STEMI patients that present directly to PCI-facility. 37 Consistent with other studies, we did not find any significant association of RIPC with in-hospital length of stay. 22,23 The present study used registry data and thus could not account for confounders that were not captured in the database including amount of intravenous fluid received during and after pPCI.…”

Section: Discussionsupporting

confidence: 92%

Renal Protection Using Remote Ischemic Peri‐Conditioning During Inter‐Facility Helicopter Transport of Patients With ST‐Segment Elevation Myocardial Infarction: A Retrospective Study

Olafiranye

Ladejobi

Wayne

et al. 2016

J Interven Cardiology

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Objective To assess the impact of remote ischemic peri-conditioning (RIPC) during inter-facility air medical transport of ST-segment elevation myocardial infarction (STEMI) patients on the incidence of acute kidney injury (AKI) following primary percutaneous coronary intervention (pPCI). Background STEMI patients who receive pPCI have an increased risk of AKI for which there is no well-defined prophylactic therapy in the setting of emergent pPCI. Methods Using the ACTION Registry-GWTG, we evaluated the impact of RIPC applied during inter-facility helicopter transport of STEMI patients from non-PCI capable hospitals to two PCI-hospitals in the United States between March, 2013 and September, 2015 on the incidence of AKI following pPCI. AKI was defined as ≥0.3mg/dl increase in creatinine within 48–72 hours after pPCI. Results Patients who received RIPC (n=127), compared to those who did not (n=92), were less likely to have AKI (11 of 127 patients [8.7%] versus 17 of 92 patients [18.5%]; adjusted odds ratio=0.32, 95% CI 0.12–0.85, p=0.023) and all-cause in-hospital mortality (2 of 127 patients [1.6%] versus 7 of 92 patients [7.6%]; adjusted odds ratio=0.14, 95% CI 0.02–0.86, p=0.034) after adjusting for socio-demographic and clinical characteristics. There was no difference in hospital length of stay (3 days [interquartile range, 2– 4] versus 3 days [interquartile range, 2– 5], p=0.357) between the two groups. Conclusion RIPC applied during inter-facility helicopter transport of STEMI patients for pPCI is associated with lower incidence of AKI and in-hospital mortality. The use of RIPC for renal protection in STEMI patients warrants further in depth investigation.

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Section: Discussionsupporting

confidence: 92%

Renal Protection Using Remote Ischemic Peri‐Conditioning During Inter‐Facility Helicopter Transport of Patients With ST‐Segment Elevation Myocardial Infarction: A Retrospective Study

Olafiranye

Ladejobi

Wayne

et al. 2016

J Interven Cardiology

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“…Our results also mirror the non-inferior outcomes associated with inter-hospital transfer in other medical and surgical settings, including: traumatic brain injuries (23,24); acute surgical conditions (25); and percutaneous coronary intervention for STsegment elevation myocardial infarctions (26)(27)(28). However, in the case of the latter, there is some evidence to suggest improved outcomes for patients who undergo direct admission to a facility providing definitive care perhaps related to the importance of a short door-to-balloon time (29,30). As in other settings, the findings we observed may be dependent on timely and efficient patient transfer and prompt initiation of RRT thereafter.…”

Section: Discussionsupporting

confidence: 68%

Interhospital Transfer and Outcomes in Patients with AKI: A Population-Based Cohort Study

et al. 2020

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Background: Patients with acute kidney injury (AKI) may require inter-hospital transfer in order to receive renal replacement therapy (RRT). Inter-hospital transfer may lead to delays in therapy resulting in poor patient outcomes. There is minimal data comparing outcomes among patients undergoing transfer for RRT versus those who receive RRT at the hospital to which they first present. Methods: We conducted a population-based cohort study of all adult patients (19 years and older) who received acute dialysis within 14 days of admission to an acute care hospital between April 1, 2004 and March 31, 2015. The transferred group included all patients who presented to a hospital without a dialysis program and underwent interhospital transfer (with the start of dialysis ≤3 days of transfer and within 14 days of initial admission). All other patients were considered non-transferred. The primary outcome was time to 90-day all-cause mortality adjusting for demographics, comorbidities and measures of acute illness severity. We also assessed chronic dialysis dependence as a secondary outcome using Fine and Gray proportional hazards model to account for the competing risks of death. In a secondary post-hoc analysis, we assessed these outcomes in a propensity-score matched cohort, matching on age, sex and prior chronic kidney disease status. Results: We identified 27,270 individuals initiating acute RRT within 14 days of a hospital admission, of whom 2,113 underwent inter-hospital transfer. Inter-hospital transfer was associated with lower rate of mortality [adjusted hazard ratio (aHR) 0.90 (95%CI: 0.84-0.97)]. Chronic dialysis dependence was not significantly different between groups [aHR 0.98 (0.91-1.06)]. In the propensity score matched analysis, interhospital transfer remained associated with a lower risk of death [HR 0.88 (0.80-0.96)]. Conclusions: Inter-hospital transfer for receipt of RRT does not confer higher mortality or worse kidney outcomes.

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“…Although, in-hospital mortality rates in the current study were similar in both groups, it was known that service times were predictive of in-hospital mortality in the entire cohort. Studies implicated inter-hospital transfers (from non-PCI centers to PCI centers) resulted in substantial delays in receiving reperfusion therapy, thereby causing subsequent larger myocardial damage [21][22][23][24]. Kawecki et al [21] indicated that direct admission to a PCI center resulted in a shorter median symptoms-to-admission time (by 44 min; p < 0.001) and a lower 12-month mortality (9.6% vs. 10.4%; p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction

Borowicz¹,

Nadolny

Bujak

et al. 2021

Cardiol J.

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Background: Time delays to reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) still remain a considerable drawback in many healthcare systems. Emergency medical service (EMS) has a critical role in the early management of STEMI. Under investigation herein, was whether the use of physician-staffed ambulances leads to shorter pre-hospital delays in STEMI patients. Methods: This was an observational and retrospective study, using data from the registry of the Silesian regional EMS system in Katowice, Poland and the Polish Registry on Acute Coronary Syndromes (PL-ACS) for a study period of January 1, 2013 to December 31, 2016. The study population (n = 717) was divided into two groups: group 1 (n = 546 patients)-physician-staffed ambulances and group 2 (n = 171 patients)-paramedic-staffed ambulances. Results: Responses during the day and night shifts were similar. Paramedic-led ambulances more often transmitted 12-lead electrocardiogram (ECG) to the percutaneous coronary intervention centers. All EMS time intervals were similar in both groups. The type of EMS dispatched to patients (physicianstaffed vs. paramedic/nurse-only staffed ambulance) was adjusted for ECG transmission, sex had no impact on in-hospital mortality (odds ratio [OR] 1.41; 95% confidence interval [CI] 0.79-1.95; p = 0.4). However, service time exceeding 42 min was an independent predictor of in-hospital mortality (OR 4.19; 95% CI 1.27-13.89; p = 0.019). In-hospital mortality rate was higher in the two upper quartiles of service time in the entire study population. Conclusions: These findings suggest that both physician-led and paramedic-led ambulances meet the criteria set out by the Polish and European authorities. All EMS time intervals are similar regardless of the type of EMS unit dispatched. A physician being present on board did not have a prognostic impact on outcomes.

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Inter-Facility Transfer vs. Direct Admission of Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Cited by 25 publications

References 25 publications

Renal Protection Using Remote Ischemic Peri‐Conditioning During Inter‐Facility Helicopter Transport of Patients With ST‐Segment Elevation Myocardial Infarction: A Retrospective Study

Renal Protection Using Remote Ischemic Peri‐Conditioning During Inter‐Facility Helicopter Transport of Patients With ST‐Segment Elevation Myocardial Infarction: A Retrospective Study

Interhospital Transfer and Outcomes in Patients with AKI: A Population-Based Cohort Study

Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction

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