AHA: Bypassing Non-PCI Hospital Ups Outcomes in STEMI

Patients transported directly to PCI center have quicker reperfusion times, lower mortality

THURSDAY, May 10 (HealthDay News) -- Patients with ST-segment elevation myocardial infarction (STEMI) who are taken directly to a percutaneous coronary intervention (PCI)-capable hospital, even if they have to bypass a closer non-PCI hospital, receive treatment significantly faster than patients who need to be transferred for treatment, according to a study presented at the American Heart Association's Quality of Care & Outcomes Research 2012 Scientific Sessions, held from May 9 to 11 in Atlanta.

Emil L. Fosbol, M.D., Ph.D., from Duke University in Durham, N.C., and colleagues selected 1,224 emergency medical service (EMS)-transported patients with STEMI who either bypassed a closer non-PCI hospital to go directly to a PCI center or were first taken to a non-PCI center and subsequently transferred for PCI.

The researchers found that 63 percent of patients bypassed a non-PCI center, while 37 percent were first treated at a non-PCI hospital and then transferred for PCI. In adjusted analyses, undergoing bypass was predicted by being of white race (odds ratio [OR], 1.37), having chest pain as the chief complaint (OR, 2.08), having received a pre-hospital 12-lead electrocardiogram (OR, 2.14), cardiogenic shock (OR, 1.82), and a prior history of PCI (OR, 1.66). Time from first-medical-contact to PCI was significantly shorter in the bypass group (95 minutes, versus 179 minutes in the non-bypass group). Compared with the non-bypass group, crude in-hospital mortality was lower in the bypass group (6.3 versus 9.4 percent; P = 0.046).

"PCI is contingent on getting the patient very quickly to a hospital with a catheter lab," Fosbol said in a statement. "Our results suggest that when logistically feasible, EMS should transfer STEMI patients directly to the nearest PCI-capable hospital."

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