Download PDF
Int J Angiol 2023; 32(02): 121-127
DOI: 10.1055/s-0040-1714686
Original Article

Interhospital Transfer versus Direct Admission in Patients with Acute ST-Segment Elevation Myocardial Infarction

Surya Dharma 
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
,
Iwan Dakota
2   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
,
Hananto Andriantoro
2   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
,
Isman Firdaus
2   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
,
Citra P. Anandira
3   Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
,
Basuni Radi
2   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

There is concern whether patients with ST-segment elevation myocardial infarction (STEMI) who admitted to a percutaneous coronary intervention (PCI) center from interhospital transfer is associated with longer reperfusion time compared with direct admission. We evaluated the reperfusion delays in patients with STEMI who admitted to a primary PCI center through interhospital transfer or direct admission. We retrospectively analyzed 6,494 consecutive STEMI patients admitted between 2011 and 2019. Compared with direct admission (n = 4,121; 63%), interhospital transferred patients (n = 2,373) were younger (55 ± 10 vs. 56 ± 10 years, p < 0.001), had similar gender (85.6 vs. 86% male, p = 0.67), greater proportion of off-hour admission (65.2 vs. 48.3%, p < 0.001), less diabetes mellitus (28 vs. 30.8%, p = 0.019), and received more primary PCI (70.5 vs. 48.7%, p < 0.001). Interhospital transferred patients who received primary PCI (n = 3,677) or fibrinolytic (n = 238) had longer symptom-to-PCI center admission time (median, 360 vs. 300 minutes, p < 0.001), shorter door-to-device (DTD) time for primary PCI (median, 74 vs. 87 minutes, p < 0.001), and longer total ischemic time (median, 465 vs. 414 minutes, p < 0.001). Logistic regression in interhospital transferred patients showed that delay in door-in-to-door-out (DI-DO) time at the first hospital was strongly associated with prolonged total ischemic time (adjusted odds ratio = 3.92; 95% confidence interval: 3.06–5.04, p < 0.001). This study suggests that although interhospital transferred patients received more primary PCI with shorter DTD time, interhospital transfer creates longer total ischemic time that associates with the delay in DI-DO time at the first hospital that should be improved.

Keywords

interhospital transfer - direct admission - STEMI - reperfusion delay

Financial support

No external funding support.




Publication History

Article published online:
25 July 2020

© 2020. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Ibanez B, James S, Agewall S. et al; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39 (02) 119-177
    CrossrefPubMedGoogle Scholar
  • 2 O'Gara PT, Kushner FG, Ascheim DD. et al; CF/AHA Task Force. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127 (04) 529-555
    CrossrefPubMedGoogle Scholar
  • 3 Tarkin J, Malhotra A, Apps A. et al. Inter-hospital transfer for primary angioplasty: delays are often due to diagnostic uncertainty rather than systems failure and universal time metrics may not be appropriate. EuroIntervention 2015; 11 (05) 511-517
    CrossrefPubMedGoogle Scholar
  • 4 Kawecki D, Gierlotka M, Morawiec B. et al. Direct admission versus interhospital transfer for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. JACC Cardiovasc Interv 2017; 10 (05) 438-447
    CrossrefPubMedGoogle Scholar
  • 5 Busk M, Maeng M, Rasmussen K. et al; DANAMI-2 Investigators. The Danish multicentre randomized study of fibrinolytic therapy vs. primary angioplasty in acute myocardial infarction (the DANAMI-2 trial): outcome after 3 years follow-up. Eur Heart J 2008; 29 (10) 1259-1266
    CrossrefPubMedGoogle Scholar
  • 6 Henry TD, Sharkey SW, Burke MN. et al. A regional system to provide timely access to percutaneous coronary intervention for ST-elevation myocardial infarction. Circulation 2007; 116 (07) 721-728
    CrossrefPubMedGoogle Scholar
  • 7 Brodie BR, Stuckey TD, Hansen CJ. et al. Effect of treatment delay on outcomes in patients with acute myocardial infarction transferred from community hospitals for primary percutaneous coronary intervention. Am J Cardiol 2002; 89 (11) 1243-1247
    CrossrefPubMedGoogle Scholar
  • 8 Ting HH, Rihal CS, Gersh BJ. et al. Regional systems of care to optimize timeliness of reperfusion therapy for ST-elevation myocardial infarction: the Mayo Clinic STEMI Protocol. Circulation 2007; 116 (07) 729-736
    CrossrefPubMedGoogle Scholar
  • 9 Dharma S, Andriantoro H, Purnawan I. et al. Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry. BMJ Open 2016; 6 (08) e012193
    CrossrefPubMedGoogle Scholar
  • 10 Dharma S, Andriantoro H, Dakota I. et al. Organisation of reperfusion therapy for STEMI in a developing country. Open Heart 2015; 2 (01) e000240
    CrossrefPubMedGoogle Scholar
  • 11 Dharma S, Juzar DA, Firdaus I, Soerianata S, Wardeh AJ, Jukema JW. Acute myocardial infarction system of care in the third world. Neth Heart J 2012; 20 (06) 254-259
    CrossrefPubMedGoogle Scholar
  • 12 Dharma S, Siswanto BB, Firdaus I. et al. Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System. PLoS One 2014; 9 (02) e86665
    CrossrefPubMedGoogle Scholar
  • 13 Dharma S, Sukmawan R, Siswanto BB, Andriantoro H, Dakota I, Rao SV. One-year mortality of primary angioplasty for acute myocardial infarction during regular working hours versus off-hours. Asia Intervention 2015; 1: 109-115 . Accessed July 8, 2020 at: https://www.asiaintervention.org/wp-content/uploads/2015/09/web21AIJv1i2_20150414_01_DharmaCR.pdf
    PubMedGoogle Scholar
  • 14 Wang TY, Nallamothu BK, Krumholz HM. et al. Association of door-in to door-out time with reperfusion delays and outcomes among patients transferred for primary percutaneous coronary intervention. JAMA 2011; 305 (24) 2540-2547
    CrossrefPubMedGoogle Scholar
  • 15 Regueiro A, Rosas A, Kaifoszova Z. et al. Impact of the “ACT NOW. SAVE A LIFE” public awareness campaign on the performance of a European STEMI network. Int J Cardiol 2015; 197: 110-112
    CrossrefPubMedGoogle Scholar
  • 16 Zeymer U, Arntz HR, Dirks B. et al; PREMIR-Investigators. Reperfusion rate and inhospital mortality of patients with ST segment elevation myocardial infarction diagnosed already in the prehospital phase: results of the German Prehospital Myocardial Infarction Registry (PREMIR). Resuscitation 2009; 80 (04) 402-406
    CrossrefPubMedGoogle Scholar
  • 17 Terkelsen CJ, Pinto DS, Thiele H. et al. 2012 ESC STEMI guidelines and reperfusion therapy: evidence base ignored, threatening optimal patient management. Heart 2013; 99 (16) 1154-1156
    CrossrefPubMedGoogle Scholar
  • 18 Granger CB, Bates ER, Jollis JG. et al. Improving care of STEMI in the United States 2008 to 2012. J Am Heart Assoc 2019; 8 (01) e008096
    CrossrefPubMedGoogle Scholar
  • 19 Sejersten M, Sillesen M, Hansen PR. et al. Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention. Am J Cardiol 2008; 101 (07) 941-946
    CrossrefPubMedGoogle Scholar
  • 20 Dakota I, Dharma S, Andriantoro H. et al. “Door-in to door-out” delay in patients with acute ST-segment elevation myocardial infarction transferred for primary percutaneous coronary intervention in a metropolitan STEMI network of a developing country. Int J Angiol 2020; 29 (01) 27-32
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Fordyce CB, Al-Khalidi HR, Jollis JG. et al; STEMI Systems Accelerator Project. Association of rapid care process implementation on reperfusion times across multiple ST-segment-elevation myocardial infarction network. Circ Cardiovasc Interv 2017; 10 (01) e004061
    CrossrefPubMedGoogle Scholar
  • 22 Dalby M, Bouzamondo A, Lechat P, Montalescot G. Transfer for primary angioplasty versus immediate thrombolysis in acute myocardial infarction: a meta-analysis. Circulation 2003; 108 (15) 1809-1814
    CrossrefPubMedGoogle Scholar