The impact of transferring patients with ST-segment elevation myocardial infarction to percutaneous coronary intervention-capable hospitals on clinical outcomes

Kim, Bo Won; Soo, Kwang; Park, Min Joung; Choi, Jong Hyun; Yun, Eun Young; Park, Jin Sup; Lee, Hye Won; Oh, Jun-Hyok; Kim, Jeong Su; Choi, Jung Hyun; Park, Young Hyun; Lee, Han Cheol; Kim, June Hong; Chun, Kook Jin; Hong, Taek Jong; Ahn, Youngkeun

doi:10.5603/cj.a2016.0003

Cited by 10 publications

(10 citation statements)

References 19 publications

(28 reference statements)

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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).…”

Section: Discussionsupporting

confidence: 71%

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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Section: Discussionsupporting

confidence: 71%

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

et al. 2020

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“…According to Korea Acute Myocardial Infarction Registry (KAMIR) statistics, 60.9% of STEMI patients first visit hospitals where PCI is not available. 12 A similar trend has been detected internationally, and in general, about half of STEMI patients visit hospitals initially where PCI is not available. 22,23 The AHA recommends a D1-to-B time of less than 120 minutes from the initial visit to a non-PCI facility to a PCI after transfer.…”

Section: Discussionsupporting

confidence: 57%

“…In the case of a transferred STEMI patient, however, the results have not been not satisfactory. According to Korea Acute Myocardial Infarction Registry (KAMIR) statistics, 60.9% of STEMI patients first visit hospitals where PCI is not available [ 12 ]. A similar trend has been detected internationally, and in general, about half of STEMI patients visit hospitals initially where PCI is not available [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, more than half of STEMI patients are referred to PCI after visiting the emergency department of a non-PCI capable hospital first [ 11 ]. According to Kim et al [ 12 ] and Park et al [ 13 ], 60.9% of STEMI patients visit non-PCI capable hospitals initially and are subsequently transferred to hospitals with a PCI facility, and the D1-to-B time of 120 minutes was observed only in 29.3% of such STEMI cases.…”

Section: Introductionmentioning

confidence: 99%

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Effect of percutaneous coronary intervention team prenotification based on real time electrocardiogram transmission in interhospital transfer of ST elevation myocardial infarction patients: pilot trial of Preparing Revascularization Effort before Patients’ Arrival via Regionalization Engagement protocol

et al. 2020

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Objective Prompt reperfusion is important for patients with ST elevation myocardial infarction (STEMI). However, patients often require interhospital transfer for percutaneous coronary intervention (PCI) because not all hospitals can provide. The purpose of this study is to reduce the PCI delay using a regionalization protocol in patients with STEMI following transfer from another hospital lacking PCI facility. Methods We established a revascularization protocol designated as Preparing Revascularization Effort before Patients' Arrival via Regionalization Engagement (PREPARE) for the STEMI patients transferred from an outside regional hospital. The protocol included immediate referral acceptance by an emergency physician, real-time electrocardiogram sharing via mobile phone and early activation of the PCI team. We analyzed the differences between the PREPARE and the non-PREPARE groups. Results In the PREPARE group, the median time from the first hospital visit to the ballooning procedure via PCI at the receiving facility (D1-to-B time) was 111.0 (interquartile range 97.0-130.0) minutes, which was significantly shorter than in the non-PREPARE group 134.0 (interquartile range 115.0-182.0) minutes. The proportion of D1-to-B time within 120 minutes was 30.4% in the group and 60.0% in the PREPARE group, which represents a significant difference (P = 0.004). Multivariate logistic regression analysis revealed that patient transfer via PREPARE protocol (odds ratio, 3.399; 95% confidence interval, 1.150-10.050, P = 0.027) was related to adequate D1-to-B time. No statistically significant differences were found in the hospital length of stay or major adverse cardiac events within 4 weeks. Conclusion The PREPARE protocol is an effective strategy to reduce the time to revascularization of the transferred STEMI patients.

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“…Wang et al 14 had reported the DTB time of 79 min vs. 36 min for such patients. Kim et al have also described the time for transfer patient to be less than the direct ER-attending patients (75 vs. 91 min) 15 . DTB in transfer patients had been taken from the door entry in our hospital and not from the door entry of the first contact of the referral doctor or hospital.…”

Section: Discussionmentioning

confidence: 77%

Door-to-balloon time and the determining factors in a tertiary cardiac center in Nepal

Dhungel

Malla

Adhikari

et al. 2018

Indian Heart Journal

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BackgroundDoor-to-balloon (DTB) time of 90 min during primary angioplasty is considered as the benchmark duration. Shorter DTB time is preferable, and longer duration can have poor clinical outcomes.MethodsA cross-sectional observational study of three months in Shahid Gangalal National Heart Center was conducted in which all patients undergoing primary angioplasty were included. The DTB time was calculated, and the different determining factors were studied.ResultsSeventy-nine patients undergoing primary percutaneous intervention were studied. The median DTB time was 79 minutes (Interquartile range [IQR] 59–115 min). Forty-six (58.2%) patients had a DTB time of less than 90 min. DTB time varied significantly with direct visit vs transfer (p = 0.029) and office time visit (9 am–5 pm) vs off time (5 pm–9 am) (p = 0.012). DTB time did not differ between any infarct-related vessels (p = 0.471), number of vessels involved (p = 0.638), and the added procedures (defibrillation, thrombosuction, and temporary pacemaker insertion) (p = 0.682) during angioplasty. No significant differences were recorded according to age (p = 0.330), gender (p = 0.254), hypertension (p = 0.073), diabetes (p = 0.487), heart failure (p = 0.316), and baseline left ventricular ejection fraction (LVEF) (p = 0.819).ConclusionThe median DTB time in primary angioplasty was less than 90 minutes. The significant determining factors were timing of hospital visit (office vs off time) and type of visit (direct vs transfer). There can be improvement in factors determining DTB time to lower it further.

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The impact of transferring patients with ST-segment elevation myocardial infarction to percutaneous coronary intervention-capable hospitals on clinical outcomes

Cited by 10 publications

References 19 publications

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

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

Door-to-balloon time and the determining factors in a tertiary cardiac center in Nepal

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