One-year clinical outcome of interventionalist- versus patient-transfer strategies for primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: results from the REVERSE-STEMI study.

Abstract

BACKGROUND:

Traditional reperfusion options for patients with acute ST-segment elevation myocardial infarction (STEMI) presenting to non-primary percutaneous coronary intervention (PPCI)-capable hospitals generally include onsite fibrinolytics or emergency transfer for PPCI. A third option, involving interventionalist transfer, was examined in the REVERSE-STEMI study.

METHODS AND RESULTS:

A total of 334 patients with acute STEMI who presented to 5 referral hospitals with angiographic facilities but without interventionalists qualified for PPCI were randomized to receive PPCI with either an interventionalist- (n=165) or a patient-transfer (n=169) strategy. The primary end point of door-to-balloon (D2B) time and secondary end points of left ventricular ejection fraction and major adverse cardiac events (MACE) at 1-year clinical follow-up were compared between the 2 groups. Compared with the patient-transfer strategy, the interventionalist-transfer strategy resulted in a significantly shortened D2B time (median, 92 minutes versus 141 minutes; P<0.0001), with more patients having first balloon angioplasty within 90 minutes (21.2% versus 7.7%, P<0.001). This treatment strategy also was associated with higher left ventricular ejection fraction (0.60±0.07 versus 0.57±0.09, P<0.001) and improved 1-year MACE-free survival (84.8% versus 74.6%, P=0.019). Multivariate Cox proportional hazards modeling revealed that the interventionalist-transfer strategy was an independent factor for reduced risk of composite MACE (hazard ratio, 0.63; 95% CI, 0.45 to 0.88; P=0.003).

CONCLUSIONS:

The interventionalist-transfer strategy for PPCI may be effective in improving the care of patients with STEMI presenting to a non-PPCI-capable hospital, particularly in a congested cosmopolitan region where patient transfers could be prolonged.

• Authors: Qi Zhang, Rui Yan Zhang, Jian Ping Qiu, Jun Feng Zhang, Xiao Long Wang, Li Jiang, Min Lei Liao, Jian Sheng Zhang, Jian Hu, Zheng Kun Yang, Wei Feng Shen
• Journal: Circulation. Cardiovascular quality and outcomes (Circ Cardiovasc Qual Outcomes) Vol. 4 Issue 3 Pg. 355-62 (May 2011) ISSN: 1941-7705 [Electronic] United States
• PMID: 21521833 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Angioplasty, Balloon, Coronary
• China
• Electrocardiography
• Female
• Follow-Up Studies
• Hospital-Physician Relations
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Myocardial Infarction (mortality, physiopathology, therapy)
• Outcome Assessment, Health Care
• Patient Transfer
• Professional Practice
• Proportional Hazards Models
• Prospective Studies
• Retrospective Studies
• Stroke Volume (physiology)
• Survival Rate
• Technology Transfer
• Time Factors
• Treatment Outcome