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

Objective-To investigate the feasibility, safety, and associated time delay s of interhospital transfer in patients with acute myocardial infarction fo r primary percutaneous transluminal coronary angio plasty (PTCA). Design and patients-Prospective abservational study with group comparison i n a single centre. 68 consecutive patients with acute myocardial infarction transferred for primary PTCA from other hospitals (group A) were compared with 78 patients admitted directly to the referral centre (group B). Main outcome measures-Patient groups were analysed with regard to baseline characteristics, time intervals from onset of chest pain to balloon angiopl asty, hospital stay, and follow up outcome. Results-Patients in group A pre sented with a higher rate of cardiogenic shock initially than patients in g roup B (25% v 6%, p = 0.01) and had been resuscitated more frequently befor e PTCA (22% v 5%, p = 0.01). No deaths or other serious complications occur red during interhospital transfer. Median transfer time was 63 (range 40-11 5) minutes for helicopter transport (median 42 (28-122) km, n=14), and 50 ( 18-110) minutes by ground ambulance (median 8 (5-68) km, n = 54). The media n time interval from the decision to perform coronary arteriography to ball oon inflation was 96 (45-243) minutes in group A and 52 (17-214) minutes in group B (p = 0.0001). In transferred patients (group A) the transportation associated delay and the longer in-hospital median decision time (50 (10- 1120) minutes in group A v 15 (0-210) minutes in group B, p = 0.002) concur red with a longer total period of ischaemia (239 (114-1307) minutes in grou p A v 182 Switzerland (75-1025) minutes in group B, p = 0.02) since the beg inning of chest pain. Success of PTCA (TIMI 3 flow in 95% of all patients), in-hospital mortality (7% v 9%, mortality for patients not in cardiogenic shock 0% v 4%), and follow up after median 235 days was similarly favourabl e in groups A and B, respectively. Only one hospital survivor (group A) die d during follow up. Conclusion-Interhospital transport for primary PTCA in high risk patients w ith acute myocardial infarction is safe and feasible within a reasonable pe riod of time. Short and medium term outcome is favourable. Optimising the d ecision process and transport logistics may further improve outcome by redu cing the total time of ischaemia.